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.form-all .form-submit-button { color: #ffffff; background: #292929; box-shadow: none; text-shadow: none;
}
.form-all .form-pagebreak-back,
.form-all .form-pagebreak-next { font-family: "Inter", sans-serif; font-size: 16px; font-weight: normal; border: none; border-width: 3px; border-style: solid; border-color: #fa8c29;
}
.form-all .form-pagebreak-back,
.form-all .form-pagebreak-next { min-width: 128px;
}
.form-all .form-pagebreak-back,
.form-all .form-pagebreak-next { box-shadow: none; text-shadow: none; color: #ffffff; background: #fa8c29;
}
li[data-type="control_image"] div { text-align: left;
}
li[data-type="control_image"] img { border: none; border-width: 0px !important; border-style: solid !important; border-color: false !important;
}
.supernova { height: 100%; background-repeat: no-repeat; background-attachment: scroll; background-position: center top; background-repeat: repeat;
}
.supernova { background-image: none;
}
#stage { background-image: none;
}
/* | */
.form-all { background-repeat: no-repeat; background-attachment: scroll; background-position: center top; background-repeat: repeat;
}
.form-header-group { background-repeat: no-repeat; background-attachment: scroll; background-position: center top;
}
.header-large h1.form-header { font-size: 2em;
}
.header-large h2.form-header { font-size: 1.5em;
}
.header-large h3.form-header { font-size: 1.17em;
}
.header-large h1 + .form-subHeader { font-size: 1em;
}
.header-large h2 + .form-subHeader { font-size: .875em;
}
.header-large h3 + .form-subHeader { font-size: .75em;
}
.header-default h1.form-header { font-size: 2em;
}
.header-default h2.form-header { font-size: 1.5em;
}
.header-default h3.form-header { font-size: 1.17em;
}
.header-default h1 + .form-subHeader { font-size: 1em;
}
.header-default h2 + .form-subHeader { font-size: .875em;
}
.header-default h3 + .form-subHeader { font-size: .75em;
}
.header-small h1.form-header { font-size: 2em;
}
.header-small h2.form-header { font-size: 1.5em;
}
.header-small h3.form-header { font-size: 1.17em;
}
.header-small h1 + .form-subHeader { font-size: 1em;
}
.header-small h2 + .form-subHeader { font-size: .875em;
}
.header-small h3 + .form-subHeader { font-size: .75em;
}
.form-header-group { text-align: left;
}
.form-header-group { font-family: "Inter", sans-serif;
}
div.form-header-group.header-large { margin: 0px -38px;
}
div.form-header-group.header-large { padding: 40px 52px;
}
.form-header-group .form-header,
.form-header-group .form-subHeader { color: 0;
}
.form-line-error { overflow: hidden; -webkit-transition-property: none; -moz-transition-property: none; -ms-transition-property: none; -o-transition-property: none; transition-property: none; -webkit-transition-duration: 0.3s; -moz-transition-duration: 0.3s; -ms-transition-duration: 0.3s; -o-transition-duration: 0.3s; transition-duration: 0.3s; -webkit-transition-timing-function: ease; -moz-transition-timing-function: ease; -ms-transition-timing-function: ease; -o-transition-timing-function: ease; transition-timing-function: ease; background-color: #ffffff;
}
.form-line-error .form-error-message { background-color: #0074c8; clear: both; float: none;
}
.form-line-error .form-error-message .form-error-arrow { border-bottom-color: #0074c8;
}
.form-line-error input:not(#coupon-input),
.form-line-error textarea,
.form-line-error .form-validation-error { border: 1px solid #0074c8; box-shadow: 0 0 3px #0074c8;
}
.supernova { background-color: #fbf7f8;
}
.supernova body { background-color: transparent;
}
.supernova .form-all,
.form-all { background-color: #fbf7f8;
}
.form-textbox,
.form-textarea,
.form-radio-other-input,
.form-checkbox-other-input,
.form-captcha input,
.form-spinner input { background-color: rgba(79, 60, 123, 0.05);
}
.form-matrix-table tr { border-color: #ead5da;
}
.form-matrix-table tr:nth-child(2n) { background-color: #f2e6e9;
}
.form-all { color: #292929;
}
.form-label-top,
.form-label-left,
.form-label-right,
.form-html { color: #292929;
}
.form-line-error { overflow: hidden; -webkit-transition-property: none; -moz-transition-property: none; -ms-transition-property: none; -o-transition-property: none; transition-property: none; -webkit-transition-duration: 0.3s; -moz-transition-duration: 0.3s; -ms-transition-duration: 0.3s; -o-transition-duration: 0.3s; transition-duration: 0.3s; -webkit-transition-timing-function: ease; -moz-transition-timing-function: ease; -ms-transition-timing-function: ease; -o-transition-timing-function: ease; transition-timing-function: ease; background-color: #ffffff;
}
.form-header-group .form-header,
.form-header-group .form-subHeader { color: 0;
} /*__INSPECT_SEPERATOR__*/
.formFooter { display : none;
} .form-textbox { border-bottom : 2px solid #292929;
} .form-pagebreak-next { border-color : #292929;
} .progressBar-newDefaultTheme .progressjs-theme-newDefault { border-radius : 10px; height : 20px!important; margin : 20px 0;
} .progressBar-newDefaultTheme .progressjs-inner { border-radius : 10px;
} .form-all { border : 3px solid #292929;
} .form-dropdown { border-bottom : 2px solid #85AF4F;
} #footer { text-align : left; margin : -35px auto 0; font-size : 14px; width : 1000px; display : none;
} .form-radio-item label { } /* Injected CSS Code */
</style> <form class="jotform-form" action="https://submit.jotform.com/submit/211137331201436/" method="post" name="form_211137331201436" id="211137331201436" accept-charset="utf-8" autocomplete="on"> <input type="hidden" name="formID" value="211137331201436" /> <input type="hidden" id="JWTContainer" value="" /> <input type="hidden" id="cardinalOrderNumber" value="" /> <div role="main" class="form-all"> <ul class="form-section page-section"> <li id="cid_208" class="form-input-wide" data-type="control_head"> <div style="display:table;width:100%"> <div class="form-header-group hasImage header-small" data-imagealign="Top"> <div class="header-logo"> <img src="https://www.jotform.com/uploads/jotformexpert/form_files/SBNP%20(1).608482908e3db3.93341801.jpg" alt="" width="350" class="header-logo-top" /> </div> <div class="header-text httac htvam"> <h3 id="header_208" class="form-header" data-component="header"> Demographic survey </h3> </div> </div> </div> </li> <li class="form-line" data-type="control_widget" id="id_66"> <div id="cid_66" class="form-input" data-layout="full"> <div style="width:100%;text-align:Center" data-component="widget-directEmbed"> <div class="direct-embed-widgets progress-bar-widget " data-type="direct-embed" style="width:1px;min-height:1px"> <div class="direct-embed-66"> <script type="text/javascript"> var progressBarqid = "66"; var onlyCountReq = "No"; var fixedProgressBar = "No"; var deleteLabelProgressBar = ""; var fieldsProgressBar = "Fields Completed"; var submitProgressBar = "Please Submit the Form"; var requiredProgressBar = "Required Fields Complete"; var barColor = "#292922"; var theme = "Island Blue"; </script> <link href="//widgets.jotform.io/progressBar/min/styles.min.css" rel="stylesheet" media="screen" /> <script src="//widgets.jotform.io/progressBar/min/scripts.min.js"></script> </div> </div> </div> </div> </li> <li class="form-line" data-type="control_radio" id="id_377"> <label class="form-label form-label-top form-label-auto" id="label_377" for="input_377"> Which category below includes your age? </label> <div id="cid_377" class="form-input-wide" data-layout="full"> <div class="form-single-column" role="group" aria-labelledby="label_377" data-component="radio"> <span class="form-radio-item" style="clear:left"> <span class="dragger-item"> </span> <input type="radio" class="form-radio" id="input_377_0" name="q377_whichCategory" value="17 or younger" /> <label id="label_input_377_0" for="input_377_0"> 17 or younger </label> </span> <span class="form-radio-item" style="clear:left"> <span class="dragger-item"> </span> <input type="radio" class="form-radio" id="input_377_1" name="q377_whichCategory" value="18-20" /> <label id="label_input_377_1" for="input_377_1"> 18-20 </label> </span> <span class="form-radio-item" style="clear:left"> <span class="dragger-item"> </span> <input type="radio" class="form-radio" id="input_377_2" name="q377_whichCategory" value="21-29" /> <label id="label_input_377_2" for="input_377_2"> 21-29 </label> </span> <span class="form-radio-item" style="clear:left"> <span class="dragger-item"> </span> <input type="radio" class="form-radio" id="input_377_3" name="q377_whichCategory" value="30-39" /> <label id="label_input_377_3" for="input_377_3"> 30-39 </label> </span> <span class="form-radio-item" style="clear:left"> <span class="dragger-item"> </span> <input type="radio" class="form-radio" id="input_377_4" name="q377_whichCategory" value="40-49" /> <label id="label_input_377_4" for="input_377_4"> 40-49 </label> </span> <span class="form-radio-item" style="clear:left"> <span class="dragger-item"> </span> <input type="radio" class="form-radio" id="input_377_5" name="q377_whichCategory" value="50-59" /> <label id="label_input_377_5" for="input_377_5"> 50-59 </label> </span> <span class="form-radio-item" style="clear:left"> <span class="dragger-item"> </span> <input type="radio" class="form-radio" id="input_377_6" name="q377_whichCategory" value="60 or older" /> <label id="label_input_377_6" for="input_377_6"> 60 or older </label> </span> </div> </div> </li> <li class="form-line" data-type="control_radio" id="id_378"> <label class="form-label form-label-top form-label-auto" id="label_378" for="input_378"> Are you White, Black or African-American, American Indian or Alaskan Native, Asian, Native Hawaiian or other Pacific Islander, or some other race? </label> <div id="cid_378" class="form-input-wide" data-layout="full"> <div class="form-single-column" role="group" aria-labelledby="label_378" data-component="radio"> <span class="form-radio-item" style="clear:left"> <span class="dragger-item"> </span> <input type="radio" class="form-radio" id="input_378_0" name="q378_areYou" value="White" /> <label id="label_input_378_0" for="input_378_0"> White </label> </span> <span class="form-radio-item" style="clear:left"> <span class="dragger-item"> </span> <input type="radio" class="form-radio" id="input_378_1" name="q378_areYou" value="Black or African-American" /> <label id="label_input_378_1" for="input_378_1"> Black or African-American </label> </span> <span class="form-radio-item" style="clear:left"> <span class="dragger-item"> </span> <input type="radio" class="form-radio" id="input_378_2" name="q378_areYou" value="American Indian or Alaskan Native" /> <label id="label_input_378_2" for="input_378_2"> American Indian or Alaskan Native </label> </span> <span class="form-radio-item" style="clear:left"> <span class="dragger-item"> </span> <input type="radio" class="form-radio" id="input_378_3" name="q378_areYou" value="Asian" /> <label id="label_input_378_3" for="input_378_3"> Asian </label> </span> <span class="form-radio-item" style="clear:left"> <span class="dragger-item"> </span> <input type="radio" class="form-radio" id="input_378_4" name="q378_areYou" value="Native Hawaiian or other Pacific islander" /> <label id="label_input_378_4" for="input_378_4"> Native Hawaiian or other Pacific islander </label> </span> <span class="form-radio-item" style="clear:left"> <span class="dragger-item"> </span> <input type="radio" class="form-radio" id="input_378_5" name="q378_areYou" value="From multiple races" /> <label id="label_input_378_5" for="input_378_5"> From multiple races </label> </span> <span class="form-radio-item" style="clear:left"> <span class="dragger-item"> </span> <input type="radio" class="form-radio" id="input_378_6" name="q378_areYou" value="Some other race" /> <label id="label_input_378_6" for="input_378_6"> Some other race </label> </span> </div> </div> </li> <li class="form-line always-hidden form-field-hidden" style="display:none;" data-type="control_textbox" id="id_379"> <label class="form-label form-label-top form-label-auto" id="label_379" for="input_379"> Please Specify: </label> <div id="cid_379" class="form-input-wide always-hidden" data-layout="half"> <input type="text" id="input_379" name="q379_pleaseSpecify" data-type="input-textbox" class="form-textbox" style="width:310px" size="310" value="" data-component="textbox" aria-labelledby="label_379" /> </div> </li> <li class="form-line" data-type="control_radio" id="id_380"> <label class="form-label form-label-top form-label-auto" id="label_380" for="input_380"> What is your gender? </label> <div id="cid_380" class="form-input-wide" data-layout="full"> <div class="form-single-column" role="group" aria-labelledby="label_380" data-component="radio"> <span class="form-radio-item" style="clear:left"> <span class="dragger-item"> </span> <input type="radio" class="form-radio" id="input_380_0" name="q380_whatIs" value="Female" /> <label id="label_input_380_0" for="input_380_0"> Female </label> </span> <span class="form-radio-item" style="clear:left"> <span class="dragger-item"> </span> <input type="radio" class="form-radio" id="input_380_1" name="q380_whatIs" value="Male" /> <label id="label_input_380_1" for="input_380_1"> Male </label> </span> <span class="form-radio-item formRadioOther" style="clear:left"> <input type="radio" class="form-radio-other form-radio" name="q380_whatIs" id="other_380" value="other" aria-label="Other" /> <label id="label_other_380" style="text-indent:0" for="other_380"> Other </label> <span id="other_380_input" class="other-input-container" style="display:none"> <input type="text" class="form-radio-other-input form-textbox" name="q380_whatIs[other]" data-otherhint="Other" size="15" id="input_380" data-placeholder="Please type another option here" placeholder="Please type another option here" /> </span> </span> </div> </div> </li> <li class="form-line form-line-column form-col-1" data-type="control_textbox" id="id_382"> <label class="form-label form-label-top form-label-auto" id="label_382" for="input_382"> What City Do You Reside In? </label> <div id="cid_382" class="form-input-wide" data-layout="half"> <input type="text" id="input_382" name="q382_whatCity" data-type="input-textbox" class="form-textbox" style="width:310px" size="310" value="" data-component="textbox" aria-labelledby="label_382" /> </div> </li> <li class="form-line form-line-column form-col-2" data-type="control_textbox" id="id_383"> <label class="form-label form-label-top form-label-auto" id="label_383" for="input_383"> Zip Code: </label> <div id="cid_383" class="form-input-wide" data-layout="half"> <input type="text" id="input_383" name="q383_zipCode" data-type="input-textbox" class="form-textbox" style="width:310px" size="310" value="" data-component="textbox" aria-labelledby="label_383" /> </div> </li> <li class="form-line" data-type="control_radio" id="id_384"> <label class="form-label form-label-top form-label-auto" id="label_384" for="input_384"> Are you now married, widowed, divorced, separated, or never married? </label> <div id="cid_384" class="form-input-wide" data-layout="full"> <div class="form-single-column" role="group" aria-labelledby="label_384" data-component="radio"> <span class="form-radio-item" style="clear:left"> <span class="dragger-item"> </span> <input type="radio" class="form-radio" id="input_384_0" name="q384_areYou384" value="Married" /> <label id="label_input_384_0" for="input_384_0"> Married </label> </span> <span class="form-radio-item" style="clear:left"> <span class="dragger-item"> </span> <input type="radio" class="form-radio" id="input_384_1" name="q384_areYou384" value="Widowed" /> <label id="label_input_384_1" for="input_384_1"> Widowed </label> </span> <span class="form-radio-item" style="clear:left"> <span class="dragger-item"> </span> <input type="radio" class="form-radio" id="input_384_2" name="q384_areYou384" value="Divorced" /> <label id="label_input_384_2" for="input_384_2"> Divorced </label> </span> <span class="form-radio-item" style="clear:left"> <span class="dragger-item"> </span> <input type="radio" class="form-radio" id="input_384_3" name="q384_areYou384" value="Separated" /> <label id="label_input_384_3" for="input_384_3"> Separated </label> </span> <span class="form-radio-item" style="clear:left"> <span class="dragger-item"> </span> <input type="radio" class="form-radio" id="input_384_4" name="q384_areYou384" value="Never married" /> <label id="label_input_384_4" for="input_384_4"> Never married </label> </span> </div> </div> </li> <li class="form-line" data-type="control_radio" id="id_385"> <label class="form-label form-label-top form-label-auto" id="label_385" for="input_385"> What is the highest level of school you have completed or the highest degree you have received? </label> <div id="cid_385" class="form-input-wide" data-layout="full"> <div class="form-single-column" role="group" aria-labelledby="label_385" data-component="radio"> <span class="form-radio-item" style="clear:left"> <span class="dragger-item"> </span> <input type="radio" class="form-radio" id="input_385_0" name="q385_whatIs385" value="Less than high school degree" /> <label id="label_input_385_0" for="input_385_0"> Less than high school degree </label> </span> <span class="form-radio-item" style="clear:left"> <span class="dragger-item"> </span> <input type="radio" class="form-radio" id="input_385_1" name="q385_whatIs385" value="High school degree or equivalent (e.g., GED)" /> <label id="label_input_385_1" for="input_385_1"> High school degree or equivalent (e.g., GED) </label> </span> <span class="form-radio-item" style="clear:left"> <span class="dragger-item"> </span> <input type="radio" class="form-radio" id="input_385_2" name="q385_whatIs385" value="Some college but no degree" /> <label id="label_input_385_2" for="input_385_2"> Some college but no degree </label> </span> <span class="form-radio-item" style="clear:left"> <span class="dragger-item"> </span> <input type="radio" class="form-radio" id="input_385_3" name="q385_whatIs385" value="Associate degree" /> <label id="label_input_385_3" for="input_385_3"> Associate degree </label> </span> <span class="form-radio-item" style="clear:left"> <span class="dragger-item"> </span> <input type="radio" class="form-radio" id="input_385_4" name="q385_whatIs385" value="Bachelor degree" /> <label id="label_input_385_4" for="input_385_4"> Bachelor degree </label> </span> <span class="form-radio-item" style="clear:left"> <span class="dragger-item"> </span> <input type="radio" class="form-radio" id="input_385_5" name="q385_whatIs385" value="Graduate degree" /> <label id="label_input_385_5" for="input_385_5"> Graduate degree </label> </span> </div> </div> </li> <li class="form-line" data-type="control_radio" id="id_386"> <label class="form-label form-label-top form-label-auto" id="label_386" for="input_386"> Which of the following categories best describes your employment status? </label> <div id="cid_386" class="form-input-wide" data-layout="full"> <div class="form-single-column" role="group" aria-labelledby="label_386" data-component="radio"> <span class="form-radio-item" style="clear:left"> <span class="dragger-item"> </span> <input type="radio" class="form-radio" id="input_386_0" name="q386_whichOf" value="Employed, working 1-39 hours per week" /> <label id="label_input_386_0" for="input_386_0"> Employed, working 1-39 hours per week </label> </span> <span class="form-radio-item" style="clear:left"> <span class="dragger-item"> </span> <input type="radio" class="form-radio" id="input_386_1" name="q386_whichOf" value="Employed, working 40 or more hours per week" /> <label id="label_input_386_1" for="input_386_1"> Employed, working 40 or more hours per week </label> </span> <span class="form-radio-item" style="clear:left"> <span class="dragger-item"> </span> <input type="radio" class="form-radio" id="input_386_2" name="q386_whichOf" value="Not employed, looking for work" /> <label id="label_input_386_2" for="input_386_2"> Not employed, looking for work </label> </span> <span class="form-radio-item" style="clear:left"> <span class="dragger-item"> </span> <input type="radio" class="form-radio" id="input_386_3" name="q386_whichOf" value="Not employed, NOT looking for work" /> <label id="label_input_386_3" for="input_386_3"> Not employed, NOT looking for work </label> </span> <span class="form-radio-item" style="clear:left"> <span class="dragger-item"> </span> <input type="radio" class="form-radio" id="input_386_4" name="q386_whichOf" value="Retired" /> <label id="label_input_386_4" for="input_386_4"> Retired </label> </span> <span class="form-radio-item" style="clear:left"> <span class="dragger-item"> </span> <input type="radio" class="form-radio" id="input_386_5" name="q386_whichOf" value="Disabled, not able to work" /> <label id="label_input_386_5" for="input_386_5"> Disabled, not able to work </label> </span> </div> </div> </li> <li class="form-line" data-type="control_radio" id="id_387"> <label class="form-label form-label-top form-label-auto" id="label_387" for="input_387"> How much total combined money did all members of your household earn? </label> <div id="cid_387" class="form-input-wide" data-layout="full"> <div class="form-single-column" role="group" aria-labelledby="label_387" data-component="radio"> <span class="form-radio-item" style="clear:left"> <span class="dragger-item"> </span> <input type="radio" class="form-radio" id="input_387_0" name="q387_howMuch387" value="$0 – $9,999" /> <label id="label_input_387_0" for="input_387_0"> $0 – $9,999 </label> </span> <span class="form-radio-item" style="clear:left"> <span class="dragger-item"> </span> <input type="radio" class="form-radio" id="input_387_1" name="q387_howMuch387" value="$10,000 – $19,999" /> <label id="label_input_387_1" for="input_387_1"> $10,000 – $19,999 </label> </span> <span class="form-radio-item" style="clear:left"> <span class="dragger-item"> </span> <input type="radio" class="form-radio" id="input_387_2" name="q387_howMuch387" value="$20,000 – $29,999" /> <label id="label_input_387_2" for="input_387_2"> $20,000 – $29,999 </label> </span> <span class="form-radio-item" style="clear:left"> <span class="dragger-item"> </span> <input type="radio" class="form-radio" id="input_387_3" name="q387_howMuch387" value="$30,000 – $39,999" /> <label id="label_input_387_3" for="input_387_3"> $30,000 – $39,999 </label> </span> <span class="form-radio-item" style="clear:left"> <span class="dragger-item"> </span> <input type="radio" class="form-radio" id="input_387_4" name="q387_howMuch387" value="$40,000 – $49,999" /> <label id="label_input_387_4" for="input_387_4"> $40,000 – $49,999 </label> </span> <span class="form-radio-item" style="clear:left"> <span class="dragger-item"> </span> <input type="radio" class="form-radio" id="input_387_5" name="q387_howMuch387" value="$50,000 – $59,999" /> <label id="label_input_387_5" for="input_387_5"> $50,000 – $59,999 </label> </span> <span class="form-radio-item" style="clear:left"> <span class="dragger-item"> </span> <input type="radio" class="form-radio" id="input_387_6" name="q387_howMuch387" value="$60,000 – $69,999" /> <label id="label_input_387_6" for="input_387_6"> $60,000 – $69,999 </label> </span> <span class="form-radio-item" style="clear:left"> <span class="dragger-item"> </span> <input type="radio" class="form-radio" id="input_387_7" name="q387_howMuch387" value="$70,000 – $79,999" /> <label id="label_input_387_7" for="input_387_7"> $70,000 – $79,999 </label> </span> <span class="form-radio-item" style="clear:left"> <span class="dragger-item"> </span> <input type="radio" class="form-radio" id="input_387_8" name="q387_howMuch387" value="$80,000 – $89,999" /> <label id="label_input_387_8" for="input_387_8"> $80,000 – $89,999 </label> </span> <span class="form-radio-item" style="clear:left"> <span class="dragger-item"> </span> <input type="radio" class="form-radio" id="input_387_9" name="q387_howMuch387" value="$90,000 – $99,999" /> <label id="label_input_387_9" for="input_387_9"> $90,000 – $99,999 </label> </span> <span class="form-radio-item" style="clear:left"> <span class="dragger-item"> </span> <input type="radio" class="form-radio" id="input_387_10" name="q387_howMuch387" value="$100,000 or more" /> <label id="label_input_387_10" for="input_387_10"> $100,000 or more </label> </span> </div> </div> </li> <li class="form-line" data-type="control_button" id="id_329"> <div id="cid_329" class="form-input-wide" data-layout="full"> <div data-align="auto" class="form-buttons-wrapper form-buttons-auto jsTest-button-wrapperField"> <button id="input_329" type="submit" class="form-submit-button submit-button jf-form-buttons jsTest-submitField" data-component="button" data-content=""> Submit </button> </div> </div> </li> <li style="display:none"> Should be Empty: <input type="text" name="website" value="" /> </li> </ul> </div> <script> JotForm.showJotFormPowered = "new_footer"; </script> <script> JotForm.poweredByText = "Powered by JotForm"; </script> <input type="hidden" class="simple_spc" id="simple_spc" name="simple_spc" value="211137331201436" /> <script type="text/javascript"> var all_spc = document.querySelectorAll("form[id='211137331201436'] .si" + "mple" + "_spc");
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