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document.writeln('		<form method="post" name="form1" enctype="multipart/form-data" action="http://www.sitemason.com/form/kx8UCs">');
document.writeln('<input type="hidden" name="referer" value="http://www.belmont.edu/reslife/NRHH/otm_program.html">');
document.writeln('<input type="hidden" name="form__current_page" value="1">		<table id="sitemason_kx8UCs" class="sitemason_form" border="0" cellspacing="0" cellpadding="0">			<tr>');
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document.writeln('		');
document.writeln('		<div>');
document.writeln('  <div align="center" style="clear: both;" class="sitemason_body">');
document.writeln('				&nbsp;<br>');
document.writeln('  </div>');
document.writeln('  <h2 class="sitemason_header" style="border-style:none; padding-top:1px; padding-bottom:1px; padding-right:5px; padding-left:5px; margin-top:6px; margin-bottom:6px; margin-right:8px; margin-left:8px; ">');
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document.writeln('      <label class="label" for="nominee_phone">Phone #</label>');
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document.writeln('      <input type="text" style="width:200px; " name="nominee_phone">');
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document.writeln('  <div class="sitemason_body" style="float:left; ">');
document.writeln('    <div style="text-align:left; width:150px; float:left;">');
document.writeln('      <label class="label" for="nominee_email">E-mail Address</label>');
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document.writeln('  <br clear="all">');
document.writeln('  <div align="center" style="clear: both;" class="sitemason_body">');
document.writeln('				&nbsp;<br>');
document.writeln('  </div>');
document.writeln('  <h2 class="sitemason_header" style="border-style:none; padding-top:1px; padding-bottom:1px; padding-right:5px; padding-left:5px; margin-top:6px; margin-bottom:6px; margin-right:8px; margin-left:8px; ">');
document.writeln('    <a name="Nominator_Information"></a><strong><font size="3">Nominator Information</font></strong></h2>');
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document.writeln('    <div style="text-align:left; width:150px; float:left;">');
document.writeln('      <label class="label" for="nominator_name">Name</label>');
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document.writeln('      <input type="text" style="width:200px; " name="nominator_name">');
document.writeln('    </div>');
document.writeln('  </div>');
document.writeln('  <br clear="all">');
document.writeln('  <div class="sitemason_body" style="float:left; ">');
document.writeln('    <div style="text-align:left; width:150px; float:left;">');
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document.writeln('  <div class="sitemason_body" style="float:left; ">');
document.writeln('    <div style="text-align:left; width:150px; float:left;">');
document.writeln('      <label class="label" for="nominator_email">E-mail Address</label>');
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document.writeln('    <div align="left" class="value" style="float:left; ">');
document.writeln('      <input type="text" style="width:200px; " name="nominator_email">');
document.writeln('    </div>');
document.writeln('  </div>');
document.writeln('  <br clear="all">');
document.writeln('  <div align="center" style="clear: both;" class="sitemason_body">');
document.writeln('				&nbsp;<br>');
document.writeln('  </div>');
document.writeln('  <h2 class="sitemason_header" style="border-style:none; padding-top:1px; padding-bottom:1px; padding-right:5px; padding-left:5px; margin-top:6px; margin-bottom:6px; margin-right:8px; margin-left:8px; ">');
document.writeln('    <a name="Logistics_of_Program"></a><p><strong><font size="3">Logistics of Program</font></strong></p></h2>');
document.writeln('  <div class="sitemason_body" style="float:left; ">');
document.writeln('    <div style="text-align:left; width:150px; float:left;">');
document.writeln('      <label class="label" for="prog_title">Program Title</label>');
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document.writeln('  <br clear="all">');
document.writeln('  <div class="sitemason_body" style="float:left; ">');
document.writeln('    <div style="text-align:left; width:150px; float:left;">');
document.writeln('      <label class="label" for="targ_pop">Target Population (#)</label>');
document.writeln('    </div>');
document.writeln('    <div align="left" class="value" style="float:left; ">');
document.writeln('      <input type="text" style="width:200px; " name="targ_pop">');
document.writeln('    </div>');
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document.writeln('  <div class="sitemason_body" style="float:left; ">');
document.writeln('    <div style="text-align:left; width:150px; float:left;">');
document.writeln('      <label class="label" for="attendance">Number of People in Attendance</label>');
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document.writeln('      <input type="text" style="width:200px; " name="attendance">');
document.writeln('    </div>');
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document.writeln('  <br clear="all">');
document.writeln('  <div class="sitemason_body" style="float:left; ">');
document.writeln('    <div style="text-align:left; width:150px; float:left;">');
document.writeln('      <label class="label" for="organizers">Number of People Needed to Organize</label>');
document.writeln('    </div>');
document.writeln('    <div align="left" class="value" style="float:left; ">');
document.writeln('      <input type="text" style="width:200px; " name="organizers">');
document.writeln('    </div>');
document.writeln('  </div>');
document.writeln('  <br clear="all">');
document.writeln('  <div class="sitemason_body" style="float:left; ">');
document.writeln('    <div style="text-align:left; width:150px; float:left;">');
document.writeln('      <label class="label" for="time_organize">Time Needed to Organize</label>');
document.writeln('    </div>');
document.writeln('    <div align="left" class="value" style="float:left; ">');
document.writeln('      <input type="text" style="width:200px; " name="time_organize">');
document.writeln('    </div>');
document.writeln('  </div>');
document.writeln('  <br clear="all">');
document.writeln('  <div class="sitemason_body" style="float:left; ">');
document.writeln('    <div style="text-align:left; width:150px; float:left;">');
document.writeln('      <label class="label" for="date">Date(s) of Program</label>');
document.writeln('    </div>');
document.writeln('    <div align="left" class="value" style="float:left; ">');
document.writeln('      <input type="text" style="width:200px; " name="date">');
document.writeln('    </div>');
document.writeln('  </div>');
document.writeln('  <br clear="all">');
document.writeln('  <div class="sitemason_body" style="float:left; ">');
document.writeln('    <div style="text-align:left; width:150px; float:left;">');
document.writeln('      <label class="label" for="cost">Cost of Program</label>');
document.writeln('    </div>');
document.writeln('    <div align="left" class="value" style="float:left; ">');
document.writeln('      <input type="text" style="width:200px; " name="cost">');
document.writeln('    </div>');
document.writeln('  </div>');
document.writeln('  <br clear="all">');
document.writeln('  <div align="center" style="clear: both;" class="sitemason_body">');
document.writeln('				&nbsp;<br>');
document.writeln('  </div>');
document.writeln('  <div class="sitemason_body" style="float:left; ">');
document.writeln('    <div style="text-align:left; ">');
document.writeln('      <label class="label" for="origin">Origin of Program (200 word maximum)</label>');
document.writeln('    </div>');
document.writeln('    <div align="left" class="value" style="">');
document.writeln('      <textarea rows="5" style="width:400px; " name="origin"></textarea>');
document.writeln('    </div>');
document.writeln('  </div>');
document.writeln('  <br clear="all">');
document.writeln('  <div align="center" style="clear: both;" class="sitemason_body">');
document.writeln('				&nbsp;<br>');
document.writeln('  </div>');
document.writeln('  <div class="sitemason_body" style="float:left; ">');
document.writeln('    <div style="text-align:left; ">');
document.writeln('      <label class="label" for="description">Short Description of Program (400 word maximum)</label>');
document.writeln('    </div>');
document.writeln('    <div align="left" class="value" style="">');
document.writeln('      <textarea rows="10" style="width:400px; " name="description"></textarea>');
document.writeln('    </div>');
document.writeln('  </div>');
document.writeln('  <br clear="all">');
document.writeln('  <div align="center" style="clear: both;" class="sitemason_body">');
document.writeln('				&nbsp;<br>');
document.writeln('  </div>');
document.writeln('  <div class="sitemason_body" style="float:left; ">');
document.writeln('    <div style="text-align:left; ">');
document.writeln('      <label class="label" for="goals">Goals of Program (200 word maximum)</label>');
document.writeln('    </div>');
document.writeln('    <div align="left" class="value" style="">');
document.writeln('      <textarea rows="5" style="width:400px; " name="goals"></textarea>');
document.writeln('    </div>');
document.writeln('  </div>');
document.writeln('  <br clear="all">');
document.writeln('  <div align="center" style="clear: both;" class="sitemason_body">');
document.writeln('				&nbsp;<br>');
document.writeln('  </div>');
document.writeln('  <div class="sitemason_body" style="float:left; ">');
document.writeln('    <div style="text-align:left; ">');
document.writeln('      <label class="label" for="lasting_effects">Positive and Lasting Effects of Program (200 word maximum)</label>');
document.writeln('    </div>');
document.writeln('    <div align="left" class="value" style="">');
document.writeln('      <textarea rows="5" style="width:400px; " name="lasting_effects"></textarea>');
document.writeln('    </div>');
document.writeln('  </div>');
document.writeln('  <br clear="all">');
document.writeln('  <div align="center" style="clear: both;" class="sitemason_body">');
document.writeln('				&nbsp;<br>');
document.writeln('  </div>');
document.writeln('  <div class="sitemason_body" style="float:left; ">');
document.writeln('    <div style="text-align:left; ">');
document.writeln('      <label class="label" for="evaluation">Evaluation of Program (200 word maximum)</label>');
document.writeln('    </div>');
document.writeln('    <div align="left" class="value" style="">');
document.writeln('      <textarea rows="5" style="width:400px; " name="evaluation"></textarea>');
document.writeln('    </div>');
document.writeln('  </div>');
document.writeln('  <br clear="all">');
document.writeln('  <div align="center" style="clear: both;" class="sitemason_body">');
document.writeln('				&nbsp;<br>');
document.writeln('  </div>');
document.writeln('  <div class="sitemason_body" style="float:left; ">');
document.writeln('    <div style="text-align:left; ">');
document.writeln('      <label class="label" for="adaptation">How could this program be adapted to other campuses (200 word maximum)?</label>');
document.writeln('    </div>');
document.writeln('    <div align="left" class="value" style="">');
document.writeln('      <textarea rows="5" style="width:400px; " name="adaptation"></textarea>');
document.writeln('    </div>');
document.writeln('  </div>');
document.writeln('  <br clear="all">');
document.writeln('  <div align="center" style="clear: both;" class="sitemason_body">');
document.writeln('				&nbsp;<br>');
document.writeln('  </div>');
document.writeln('  <h2 class="sitemason_header" style="border-style:none; padding-top:1px; padding-bottom:1px; padding-right:5px; padding-left:5px; margin-top:6px; margin-bottom:6px; margin-right:8px; margin-left:8px; ">');
document.writeln('    <a name="Nomination_in_Brief"></a><p><strong><font size="3">Nomination in Brief</font></strong></p></h2>');
document.writeln('  <div class="sitemason_body" style="float:left; ">');
document.writeln('    <div style="text-align:left; ">');
document.writeln('      <label class="label" for="nomination_brief">Please give a short 3-4 sentence summary of the OTM nomination.</label>');
document.writeln('    </div>');
document.writeln('    <div align="left" class="value" style="">');
document.writeln('      <textarea rows="5" style="width:400px; " name="nomination_brief"></textarea>');
document.writeln('    </div>');
document.writeln('  </div>');
document.writeln('  <br clear="all">');
document.writeln('  <div align="center" style="clear: both;" class="sitemason_body">');
document.writeln('				&nbsp;<br>');
document.writeln('  </div>');
document.writeln('  <h2 class="sitemason_header" style="border-style:none; padding-top:1px; padding-bottom:1px; padding-right:5px; padding-left:5px; margin-top:6px; margin-bottom:6px; margin-right:8px; margin-left:8px; ">');
document.writeln('    <a name="Submit_Your_Nomination"></a><strong><font size="3">Submit Your Nomination</font></strong></h2>');
document.writeln('  <div class="sitemason_body" style="text-align:left; border-style:none; margin-bottom:14px; ">');
document.writeln('    <div><p><em>Thank you for taking the time to submit a nomination. You will receive an electronic copy of your&nbsp;OTM shortly. </em></p><br clear="all">');
document.writeln('    </div>');
document.writeln('  </div>');
document.writeln('  <div class="sitemason_body" align="center" style="text-align:center; ">');
document.writeln('    <input type="submit" name="submit" value="Submit">');
document.writeln('  </div>');
document.writeln('  <br clear="all">');
document.writeln('</div>');
document.writeln('');
document.writeln('				</td>');
document.writeln('			</tr>');
document.writeln('			</table>');
document.writeln('		</form>');
