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DOS webform_20160111154118.html
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<HTML><head><meta http-equiv="x-ua-compatible" content="IE=EmulateIE9">
<META HTTP-EQUIV="Content-type" CONTENT="text/html; charset=utf-8">
<title>Submit Issue to Dean of Students</title><link type="text/css" rel="stylesheet" href="/tmp/css/base.css?VERSION=11.6.04-11">
<link type="text/css" rel="stylesheet" href="/tmp/css/global.css?VERSION=11.6.04-11">
<link type="text/css" rel="stylesheet" href="/tmp/css/bmc.css?VERSION=11.6.04-11">
<link type="text/css" rel="stylesheet" href="/tmp/javascript/yui/build/fonts/fonts-min.css?VERSION=11.6.04-11">
<!--[if IE]><link type="text/css" rel="stylesheet" href="/tmp/css/ie.css?VERSION=11.6.04-11">
<![endif]--><script type="text/javascript" defer="defer" src="/tmp/javascript/ResizeDocument.js?VERSION=11.6.04-11"></script>
<style type="text/css">
/* FP VERSION: 11.6.04 */
/* styles for Quick Templates and Preventive Maintenance issue form */
.hidden_field{
display:none;
}
.ygtvitem, .ygtvlabel, .ygtvlabel:link .ygtvlabel:visited, .ygtvlabel:hover{background-color:#FFFFFF !important;}
.ygtvfocus, .ygtvfocus .ygtvlabel, .ygtvfocus .ygtvlabel:hover{font-weight:bold;background-color:#FFFFFF !important;}
.ygtvfocus .emptyGroup{font-weight:normal;background-color:#FFFFFF !important;}
/* td.fieldLabel - apply to the cell holding label for proj and ab field input */
td.fieldLabel, div.fieldLabel
{
text-align: left;
font-weight: bold;
vertical-align: top;
/* white-space:nowrap; */
}
/* td.fieldInput - apply to the cell holding input for proj and ab field */
td.fieldInput, div.fieldInput
{
text-align: left;
/* white-space: nowrap; */
vertical-align: top;
}
div.fieldInput, div.fieldLabel
{
white-space: nowrap;
}
/* fix what ext-all.css took away */
td.fieldInput ul,td.fieldInput ol, div.fieldInput ul,div.fieldInput ol, span.description ul, span.description ol { margin: 20px; }
td.fieldInput ul, div.fieldInput ul, span.description ul, span.description ul li { list-style: disc; }
td.fieldInput ul ul, div.fieldInput ul ul, span.description ul ul { list-style: circle; }
td.fieldInput ul ul ul, div.fieldInput ul ul ul, span.description ul ul ul { list-style: square; }
td.fieldInput ol, div.fieldInput ol, span.description ol { list-style: decimal; }
td.fieldInput strong, div.fieldInput strong, td.fieldInput th, span.description strong, span.description th { font-weight: bold; }
table.straightenColumnsSingle td .indented
{
margin-left: 0;
}
/* notice the input cell doesn't get a width within straightenColumnsSingle tables */
table.straightenColumns td.fieldInput,
table.straightenColumns div.fieldInput
{
/* width: 20%;*/
white-space:nowrap;
}
table.straightenColumns td.dateFieldInput,
table.straightenColumns span.dateFieldInput
{
width: 30%;
}
/* select.ticketField -- apply to text inputs, dropdowns and multi-selects used for project and ab fields */
.cell .fieldInput select.ticketField, .cell .fieldInput input.ticketField, .cell .fieldInput textarea.ticketField
{
width: 98%;
}
.cols-2 .cell .fieldInput textarea.ticketField, .cols-3 .cell .fieldInput textarea.ticketField
{
width: 90%;
}
.cols-4 .cell .fieldInput textarea.ticketField, .cols-5 .cell .fieldInput textarea.ticketField, .cols-6 .cell .fieldInput textarea.ticketField
{
width: 80%;
}
/* sfi - subtask field inheritance; set on the create template page; if present - takes part of the input div */
.ticketFieldIncludeSFI
{
width: 80%;
}
select.ticketTitleInput, input.ticketTitleInput
{
width: 40em;
}
/* table.dialog -- these are the islands you find in places like the create page. Style makes them spaced apart and proper bgcolor */
table.dialog
{
margin-bottom: 6px;
background-color: #FFFFFF;
border: 1px solid #006699;
width: 100%;
}
.FBstyle table.dialog
{
border: 1px solid #cccccc;
}
/* combine with above to remove border */
table.nested
{
border: none;
}
/* pair this with table.dialog to override the blue border on a tab group */
table.tabbed
{
/* border: 1px outset threedhighlight !important;*/
}
table.tabbed
{
/* Let's us come closer to bottom of screen without scrollbars appearing on window */
margin-bottom: 0px;
/* fixes misaligment of tab menu caused by a rule in reset.css*/
border-collapse: separate;
}
/* rounded dialogs combine table.dialog and table.roundedDialog to remove border */
table.roundedDialog
{
border: none;
}
/* table.dialogHeading -- used to start off a floating table with a dark bar going across top */
table.dialogHeading
{
height: 26px;
background-color: #006699;
background-image: url(/MRimg/gradientDialog_sys.gif);
background-position: bottom;
width: 100%;
color: #FFFFFF;
}
.FBstyle table.dialogHeading, .FBstyle table.dialogHeading td.dialogTitle
{
/* taken partially from .pageHeader */
font-size: 13px;
color: #006699;
font-weight: bold;
/* additional */
background-color: #FFFFFF;
margin-top: 5px;
margin-left: 8px;
width: 98%;
background-image: none;
}
.FBstyle table.dialogHeading td.dialogTitle
{
/*display: block;*/
width:400px;
}
/* td.dialogTitle -- to format the title of a floating table */
table.dialogHeading td.dialogTitle
{
padding-left: 4px;
font-weight: bold;
font-size: 9pt;
font-family: Arial;
}
/* td.dialogHeadingItem -- cell for the controls that could go along the top of a dialog */
table.dialogHeading td.dialogHeadingItem
{
white-space: nowrap;
}
/* any dropdown along the header bar should have inverse colors and bold text */
table.dialogHeading td select
{
color: #006699;
/* background-color: #FFFFFF; */
font-weight: bold;
}
td.dialogMainContent
{
padding: 3px 4px 11px 11px;
width: 100%;
}
/* Used for displaying controls at the top of an expand/collapse or tabbed dialog */
table.inlineDialogHeading
{
margin-bottom: 6px;
}
table.inlineDialogHeading td
{
padding-right: 24px;
}
/* tr.homepageRow - Homepage ticket row */
tr.homepageRow
{
background-color: #E4E1DC;
}
/* this makes the assignees dropdown match the background color of the rest of the row */
tr.homepageRow select
{
background-color: #E4E1DC;
}
/* tr.selectedRow - When you mouseover a homepage ticket row */
tr.selectedRow, tr.selectedRow select
{
cursor: pointer;
background-color: #F0EFEA;
}
tr.homepageRow td, tr.selectedRow td
{
border-bottom: 1px outset threedhighlight;
}
tr.homepageRow td.leftEdge, tr.selectedRow td.leftEdge
{
border-left: 1px outset threedshadow;
}
tr.homepageRow td.rightEdge, tr.selectedRow td.rightEdge
{
border-right: 1px solid threedshadow;
}
/* tr.homepageTopRow - bar along the top of homepage table containing the display dropdown */
tr.homepageTopRow
{
background-color: #006699;
background-image: url(/MRimg/gradientDialog_sys.gif);
background-position: bottom;
}
/* set text attributes for the whole top row including the nested table */
tr.homepageTopRow, tr.homepageTopRow table
{
text-align: left;
color: #FFFFFF;
font-weight: bold
}
tr.homepageTopRow td
{
border-top: 1px outset threedhighlight;
border-top: 1px solid #006699;
}
/* this is to prevent the previous declaration from carrying into subtables in the homepageTopRow row. IE 6 doesn't handle child selector or I'd use that*/
tr.homepageTopRow table td
{
border-top: none;
}
tr.homepageTopRow td.rightEdge
{
border-right: 1px solid #006699;
}
tr.homepageTopRow td.leftEdge
{
border-left: 1px solid #006699;
}
tr.homepageTopRow span /* handles the refresh button text */
{
color: #FFFFFF;
}
tr.homepageTopRow select /* homepage display dropdown */
{
color: #006699;
background-color: #FFFFFF;
font-weight: bold;
}
/* apply to column headings along top of homepage list */
tr.homepageHeadingsRow th
{
height: 22px;
vertical-align: bottom;
text-align: left;
font-weight: bold;
color: #006699;
background-color: #D5DFE5; /* matches toolbar frame background */
border-right: 1px solid #006699;
border-bottom: 1px solid #006699;
padding-left: 4px; /* space between text and separator */
}
tr.homepageHeadingsRow th.rightEdge
{
border-right: 1px solid #006699;
}
tr.homepageHeadingsRow th.leftEdge
{
border-left: 1px solid #006699;
border-right: none;
}
/* make sure links within column headings won't take on the VLINK, LINK or ALINK colors
this should match color of tr.homepageHeadingsRow */
tr.homepageHeadingsRow th a:link { color: #006699; text-decoration: none; }
tr.homepageHeadingsRow th a:hover { text-decoration: underline; }
body
{
color: black;
background-color: #EFEFEF;
}
body.tightPage { margin: 1px .125in 6px .125in; }
/* CI Toolbar needs to have the same background as the page body */
.citoolbar{background-color: #EFEFEF;}
/* table.projectTotals -- project totals and global issues tables that go at the top of homepage */
table.projectTotals
{
color : #777777;
}
table.projectTotals a
{
color : #777777;
}
/* td.projectTotalsContainer -- holds the project totals and global issues tables */
td.projectTotalsContainer
{
background-color: #E4E1DC;
text-align: center;
vertical-align: top;
border: solid 1px navy;
}
*.pageHeader
{
font-size: 13px;
color: #006699;
font-weight: bold;
display: block;
margin-bottom: 8px;
}
/* a heading placed inside an island to divide the island's content */
*.internalHeader
{
text-transform: uppercase;
font-size: 10pt;
color: #777777;
font-weight: bold;
display: block;
margin-top: 8px;
margin-bottom: 4px;
margin-top: 24px; /* assume we're not the first in a series of sections */
}
*.firstInternalHeader
{
margin-top: 4px;
}
/* text to introduce a section after an internalHeader */
div.sectionIntro
{
margin-top: 2px;
margin-bottom: 12px;
}
table.reportTable
{
border: 1px solid black;
}
tr.reportHeadingsRow
{
background-color: #F0EFEA;
}
th.reportColumnTitle, td.reportColumnTitle
{
font-weight: bold;
vertical-align: bottom;
text-align: center;
}
th.reportRowTitle, td.reportRowTitle
{
font-weight: bold;
font-style: italic;
text-align: left;
background-color: #E4E1DC;
white-space: nowrap;
border-top: 1px solid black;
}
td.reportDataCell
{
border-top: 1px solid black; border-left: 1px solid black;
text-align: right;
padding: 5px;
}
div.reportTimestamp
{
text-align: right;
font-size: xx-small;
color: #006699;
margin-top: 50px;
margin-right:14px;
}
/* rules for assignee picker with teams. This does not work in IE */
option.member { padding-left: 2em; }
option.team, option.tabBreak
{
background-color: #006699;
color: #FFFFFF;
font-weight: bold;
border-color: black;
border-style: solid;
border-width: 1px 0px 1px 0px;
margin: 1px 0px 1px 2px;
}
/* used on field maintenance and CI Type config. overriding bg color defined above; */
option.tabBreak { background-color: dodgerblue; border-width:1px; }
option + option.tabBreak { margin-top: 6px; }
.mandatory { color: #990000; } /* an element using this class will cause the tab containing it to appear red too */
.note { color: #990000; font-style: italic; font-weight: bold; }
/* only visible when the labels they belong to are mandatory */
span.asteriskHolder { display: none; }
label.mandatory span.asteriskHolder { display: inline; }
a.button:link, a.button:visited, a.button:hover, a.button:active
{
text-decoration: none;
color: black;
}
div.button_off
{
border: none;
padding: 3px 4px 3px 4px;
}
div.button_on
{
border: outset threedhighlight 2px;
padding: 1px 2px 1px 2px;
}
div.button_pressed
{
border: inset threedhighlight 2px;
padding: 2px 1px 0px 3px;
}
/* these are the messages given after a ticket gets created or edited */
*.refreshMessage
{
color: #006699;
font-style: italic;
display: block;
margin-bottom: 6px;
}
/* for disabled form fields and associated text */
.disabled, .perms-disabled
{
color: #808080;
}
/* Skin YUI and ExtJS components to match our theme */
.yui-panel
{
margin-bottom: 6px;
background-color: #FFFFFF;
width: 100%;
border: 1px solid #006699;
}
.yui-panel .hd
{
background-color: #006699;
background-image: url(/MRimg/gradientDialog_sys.gif);
background-position: bottom;
color: #FFFFFF;
border: none;
}
.yui-panel .bd, .yui-panel .ft
{
background-color: #FFFFFF;
}
/* to use same close icon ExtJs uses */
.yui-panel .container-close
{
background: transparent url(/tmp/javascript/ext/resources/images/default/panel/tool-sprites.gif) no-repeat scroll 0 0;
height: 15px;
width: 15px;
top: 2px;
}
/* these need to be marked !important because often we'll load an Ext theme after printing them */
.x-window-tc { background: #006699 url(/MRimg/gradientComponent_sys.gif) repeat-x !important; text-align: left; }
.x-window-tl { background: url(/MRimg/componentTopLeft_sys.gif) no-repeat !important }
.x-window-tr { background: url(/MRimg/componentTopRight_sys.gif) repeat-x scroll right top !important }
.x-window-bl { background: url(/MRimg/componentBottomLeft_sys.gif) no-repeat scroll left bottom !important; }
.x-window-br { background: url(/MRimg/componentBottomRight_sys.gif) no-repeat scroll right bottom !important }
.x-window-ml, .x-window-mr { background: #006699 !important }
.x-window-bc { background: #FFFFFF !important; border-bottom: 3px solid #006699 }
/* to make the bottom, left & right edges line up with our smaller corner images */
.x-window-ml { padding-left: 4px !important; }
.x-window-mr { padding-right: 4px !important; }
.x-window-bc .x-window-footer { padding-bottom: 3px !important; }
.x-window-bl { padding-left: 11px !important }
.x-window-br { padding-right: 11px !important }
.x-window-mc { border: none !important; text-align: left; background: #FFFFFF !important;}
.x-window-header-text { color: #FFFFFF !important; font-size: 10pt !important}
.fp-large-title .x-window-header-text { font-size: 15pt !important; }
.x-window-plain .x-window-body, .x-window-body { background: #FFFFFF !important; }
/* make window footer match table color */
.x-panel-btns-ct { background: #FFFFFF !important;}
/* this is useful in general */
.x-window-body { padding: 10px !important }
.x-window-bwrap .x-window-ml .x-window-mr .x-window-mc .x-window-body { position: relative; }
/* configure an Ext.menu with cls: 'fp-no-icon-menu' and there will not be a space reserved on the left for an icon */
.fp-no-icon-menu { background: #f0f0f0 }
.fp-no-icon-menu A.x-menu-item { padding-left: 3px; }
/* Set minimal width for non mobile pages */
.MinWidth {min-width: 900px;}
/* Overloaded color settings */
#ContentWrapper {
background-color: #FFFFFF;
box-shadow:0px 0px 15px #858585
}
/*#Nav { background-color: #D5DFE5; border-bottom-color: #006699;}*/ /* from custom.css */
/*#Nav li a:hover { color: #006699; }*/ /* from custom.css */
/*#Nav li ul { border-color: #006699; }*/ /* from custom.css */
div#Nav li a:hover {
color: #006699;
}
div#Nav li ul {
border-color: #006699;
}
div#NavBg {
height: 100%;
background: #D5DFE5;
background: -moz-linear-gradient(top, #ffffff, #D5DFE5);
background: -webkit-gradient(linear, left top, left bottom, color-stop(0%,#ffffff), color-stop(100%,#D5DFE5));
background: -webkit-linear-gradient(top, #ffffff, #D5DFE5);
background: -o-linear-gradient(top, #ffffff, #D5DFE5);
background: -ms-linear-gradient(top, #ffffff, #D5DFE5);
background: linear-gradient(top, #ffffff, #D5DFE5);
background: linear-gradient(top, #ffffff, #D5DFE5);
filter: progid:DXImageTransform.Microsoft.gradient(GradientType=0,startColorstr='#ffffff', endColorstr='#D5DFE5');
-ms-filter: "progid:DXImageTransform.Microsoft.gradient(GradientType=0,startColorstr='#ffffff', endColorstr='#D5DFE5')";
zoom: 1;
}
/* toolbar icons */
div#NavBg a.toolbar-link img {
max-height: 28px;
max-width: 33px;
}
#Widgets {
background: #FFFFFF;
background: -moz-linear-gradient(top, #D5DFE5, #FFFFFF);
background: -webkit-gradient(linear, left top, left bottom, color-stop(0%,#D5DFE5), color-stop(100%,#FFFFFF));
background: -webkit-linear-gradient(top, #D5DFE5, #FFFFFF);
background: -o-linear-gradient(top, #D5DFE5, #FFFFFF);
background: -ms-linear-gradient(top, #D5DFE5, #FFFFFF);
background: linear-gradient(top, #D5DFE5, #FFFFFF);
background: linear-gradient(top, #D5DFE5, #FFFFFF);
filter: progid:DXImageTransform.Microsoft.gradient(GradientType=0,startColorstr='#D5DFE5', endColorstr='#FFFFFF');
-ms-filter: "progid:DXImageTransform.Microsoft.gradient(GradientType=0,startColorstr='#D5DFE5', endColorstr='#FFFFFF')";
zoom: 1;
}
a#Project
{
color: #006699;
}
.breadcrumbdarkblue
{
color: #006699;
}
table.tickets td { color: #777777; } /* from homepage.css */
table.tickets { border: 1px solid #006699; width: 100% } /* from homepage.css */
table.tickets th /* from homepage.css */
{
background-image: url(/MRimg/gradientDialog_sys.gif);
background-color: #006699;
}
table.tickets th, table.tickets th a { color: #FFFFFF; } /* from homepage.css */
.quiet { color: #777777 !important;} /* from global.css */
/* Document Resizing Mechanism */
.DocumentWidth { width: 950px; }
.DocumentSubWidth { width: 936px; }
/*dependency group color regions*/
.dependency-1, .dependency-parent-1, .cell.dependency-parent-1, .dependency-1 .cell .fieldLabel div, .dependency-parent-1.cell .fieldLabel div,
.dependency-5, .dependency-parent-5, .cell.dependency-parent-5, .dependency-5 .cell .fieldLabel div, .dependency-parent-5.cell .fieldLabel div,
.dependency-9, .dependency-parent-9, .cell.dependency-parent-9, .dependency-9 .cell .fieldLabel div, .dependency-parent-9.cell .fieldLabel div,
.dependency-13, .dependency-parent-13, .cell.dependency-parent-13, .dependency-13 .cell .fieldLabel div, .dependency-parent-13.cell .fieldLabel div {
background-color: #FAFAD2 !important;
}
.dependency-2, .dependency-parent-2, .cell.dependency-parent-2, .dependency-2 .cell .fieldLabel div, .dependency-parent-2.cell .fieldLabel div,
.dependency-6, .dependency-parent-6, .cell.dependency-parent-6, .dependency-6 .cell .fieldLabel div, .dependency-parent-6.cell .fieldLabel div,
.dependency-10, .dependency-parent-10, .cell.dependency-parent-10, .dependency-10 .cell .fieldLabel div, .dependency-parent-10.cell .fieldLabel div,
.dependency-14, .dependency-parent-14, .cell.dependency-parent-14, .dependency-14 .cell .fieldLabel div, .dependency-parent-14.cell .fieldLabel div {
background-color: #E6E6FA !important;
}
.dependency-3, .dependency-parent-3, .cell.dependency-parent-3, .dependency-3 .cell .fieldLabel div, .dependency-parent-3.cell .fieldLabel div,
.dependency-7, .dependency-parent-7, .cell.dependency-parent-7, .dependency-7 .cell .fieldLabel div, .dependency-parent-7.cell .fieldLabel div,
.dependency-11, .dependency-parent-11, .cell.dependency-parent-11, .dependency-11 .cell .fieldLabel div, .dependency-parent-11.cell .fieldLabel div,
.dependency-15, .dependency-parent-15, .cell.dependency-parent-15, .dependency-15 .cell .fieldLabel div, .dependency-parent-15.cell .fieldLabel div {
background-color: #FFDDFF !important;
}
.dependency-4, .dependency-parent-4, .cell.dependency-parent-4, .dependency-4 .cell .fieldLabel div, .dependency-parent-4.cell .fieldLabel div,
.dependency-8, .dependency-parent-8, .cell.dependency-parent-8, .dependency-8 .cell .fieldLabel div, .dependency-parent-8.cell .fieldLabel div,
.dependency-12, .dependency-parent-12, .cell.dependency-parent-12, .dependency-12 .cell .fieldLabel div, .dependency-parent-12.cell .fieldLabel div,
.dependency-16, .dependency-parent-16, .cell.dependency-parent-16, .dependency-16 .cell .fieldLabel div, .dependency-parent-16.cell .fieldLabel div {
background-color: #CFFFEE !important;
}
strong, b {font-weight: bolder;}
i, cite, em, var, address {font-style: italic;}
/*active tab should have the same color as the body background*/
#VerticalTabsAndMenuHolder #tabMenu ul li.chosen {background: #FFFFFF;}
/*subtasks checkboxes*/
.SubtasksUpdaterFS {
display: inline; border: none; padding: 0px 5px 0px 0px
}
.SubtasksUpdaterFS .subtaskSpan {margin-right: 12px;float:left;}
.SubtasksUpdaterFS .subtaskSpan label {display:inline}
/* social media */
div.smc_bc_label{
text-align: right; padding: 5px 15px;
}
div.fieldGroupContainer{
border: 1px solid #cccccc;
padding: 5px;
margin-right: 5px;
}
div.fieldGroupHeader{
font-weight: bold;
border-bottom: 1px solid #cccccc;
padding-bottom: 3px;
}
div.fieldGroupContent{
}
</style>
<script type="text/javascript">
function highlightButton(isOn, id)
{
theEl = document.getElementById(id);
if (isOn)
theEl.className = "button_on";
else
theEl.className = "button_off";
}
function mousedownButton(id)
{
theEl = document.getElementById(id);
theEl.className = "button_pressed";
}
</script>
</head><BODY bgcolor = "#FFFFFF">
<FORM name = "HTML_FORM" METHOD=POST ACTION="https://sos.cnm.edu/MRcgi/MRProcessIncomingForms.pl">
<BR>
<TABLE BORDER=0 CELLPADDING=0 CELLSPACING=0 class = "dialog" width="100%">
<tr class = "dialogHeading"><td><table border = "0" class = "dialogHeading"><tr><td class = "dialogTitle">
<font size="4">Student Complaint Form</font></td></tr></table></td></tr><tr><td>
<font face=""Verdana, Arial, Helvetica, sans-serif"" size="-1" color = "#990000"> ** Mandatory fields are highlighted and preceded by an asterisk</font><p><B>
<p>CNM will not allow any form of retaliation against individuals who file a complaint with the CNM administration or who cooperate in the investigation of such reports. To the extent possible, the confidentiality of the reports will be maintained.
<br><i>Please note: This form may also be used to communicate compliments or affirmations of outstanding service and/or attitude from members of the CNM community.</i></p>
<BR>
</TD>
</TR>
</TABLE>
<BR>
<TABLE BORDER=0 CELLPADDING=0 CELLSPACING=0 class = "dialog" width="100%">
<TR class = "dialogHeading">
<td><table border = "0" class = "dialogHeading"><tr><td class = "dialogTitle">
<font size="4">Contact Information</font></td></tr></table></td></tr>
<tr><td class = "dialog"><br><table border=0><TR>
<Th align = "left">
<FONT COLOR = "#990000">*First Name</font>
</th>
<td><INPUT NAME="First__bName" SIZE="20" VALUE=""><BR></td>
<Th align = "left">
<FONT COLOR = "#990000">*Last Name</font>
</th>
<td><INPUT NAME="Last__bName" SIZE="20" VALUE=""><BR></td>
<Th align = "left">
<FONT COLOR = "#990000">*Email Address</font>
</th>
<td><INPUT NAME="Email__bAddress" SIZE="20" VALUE=""><BR></td>
</TD>
</TR>
<TR>
<Th align = "left">
<FONT COLOR = "#990000">*User Name</font>
</th>
<td><INPUT placeholder="If none type email address" NAME="User__bName" SIZE="20" VALUE=""><BR></td>
<Th align = "left">
Phone</font>
</th>
<td><INPUT NAME="CNM__bPhone" SIZE="20" VALUE=""><BR></td>
<Th align = "left">
CNM ID Number</font>
</th>
<td><INPUT NAME="CNM__bID__bNumber" SIZE="20" VALUE=""><BR></td>
</tr>
<tr>
<Th align = "left">
Student Address</font>
</th>
<td><INPUT NAME="Student__bAddress" SIZE="20" VALUE=""><BR></td>
<Th align = "left">
City</font>
</th>
<td><INPUT NAME="City" SIZE="20" VALUE=""><BR></td>
<Th align = "left">
State</font>
</th>
<td><INPUT NAME="State" SIZE="20" VALUE=""><BR></td>
<tr>
<Th align = "left">
Zip Code</font>
</th>
<td><INPUT NAME="Zip__bCode" SIZE="20" VALUE=""><BR></td>
<Th align = "left" class="hidden_field">
Alt Phone - Cell</font>
</th>
<td><INPUT class="hidden_field" NAME="Alt__bPhone__b__u__bCell" SIZE="20" VALUE=""><BR></td>
</TD>
</TR>
<TR>
<Th align = "left" class="hidden_field">
Alt Phone - Home</font>
</th>
<td><INPUT class="hidden_field" NAME="Alt__bPhone__b__u__bHome" SIZE="20" VALUE=""><BR></td>
<Th align = "left" class="hidden_field">
Job Title</font>
</th>
<td><INPUT class="hidden_field" NAME="Job__bTitle" SIZE="20" VALUE=""><BR></td>
</TD>
</TR>
<TR>
<Th align = "left" class="hidden_field">
Department</font>
</th>
<td><INPUT class="hidden_field" NAME="Department" SIZE="20" VALUE=""><BR></td>
<Th align = "left" class="hidden_field">
Office Location</font>
</th>
<td><INPUT class="hidden_field" NAME="Office__bLocation" SIZE="20" VALUE=""><BR></td>
<Th align = "left" class="hidden_field">
Campus</font>
</th>
<td><INPUT class="hidden_field" NAME="Campus" SIZE="20" VALUE=""><BR></td>
</TD>
</TR>
<TR>
<Th align = "left" class="hidden_field">
Alt Phone - Pager</font>
</th>
<td><INPUT class="hidden_field" NAME="Alt__bPhone__b__u__bPager" SIZE="20" VALUE=""></td>
<Th align = "left" class="hidden_field">
Full Name</font>
</th>
<td><INPUT class="hidden_field" NAME="Full__bName" SIZE="20" VALUE=""></td>
</TD>
</TR>
</TABLE></td></tr></table></table><br></table>
<TABLE BORDER=0 CELLPADDING=0 CELLSPACING=0 class = "dialog" width="100%">
<TR class = "dialogHeading">
<td><table border = "0" class = "dialogHeading"><tr><td class = "dialogTitle">
<font size="4">Issue Information</font></td></tr></table></td></tr>
<tr><td class = "dialog"><br><table border=0><TR>
<Table>
<Th align = "left">
<FONT COLOR = "#990000">*Subject:</FONT>
</th>
<td> <INPUT TYPE=TEXT NAME=TITLE SIZE=70 VALUE="" MAXLENGTH="250"><BR></td>
</Table>
<br>
<table>
<tr>
<Th align = "left">
<FONT COLOR = "#990000">*Feedback</font>
</th>
<td><SELECT NAME="Feedback" >
<OPTION VALUE ="Select Choice" >Select Choice</OPTION>
<OPTION VALUE ="Complaint" >Complaint</OPTION>
<OPTION VALUE ="Compliment" >Compliment</OPTION>
<OPTION VALUE ="General Feedback" >General Feedback</OPTION>
</SELECT></FONT><BR></td>
<Th align = "left">
Student Status</font>
</th>
<td><SELECT NAME="Student__bStatus" >
<OPTION VALUE ="No Choice" >No Choice</OPTION>
<OPTION VALUE ="Current Student" >Current Student</OPTION>
<OPTION VALUE ="Former Student" >Former Student</OPTION>
<OPTION VALUE ="Other" >Other</OPTION>
</SELECT></FONT><BR></td>
</TD>
</TR>
<TR>
<Th align = "left">
Feedback Category</font>
</th>
<td><INPUT TYPE=HIDDEN NAME=MULTIVALUE_FIELDS VALUE="Feedback__bCategory"><SELECT NAME="Feedback__bCategory" SIZE=4 MULTIPLE>
<OPTION VALUE ="Service" >Service</OPTION>
<OPTION VALUE ="Building" >Building</OPTION>
<OPTION VALUE ="Individual" >Individual</OPTION>
<OPTION VALUE ="Coursework" >Coursework</OPTION>
<OPTION VALUE ="Other" >Other</OPTION>
</SELECT></FONT><BR></td>
<Th align = "left">
Date Event Occured</font>
</th>
<TD>
<TABLE border=0>
<TR>
<TH nowrap> Mon Day Year </B>
</Th>
<th> Hour Minute </th>
</TR>
<TR>
<TH nowrap>
<INPUT TYPE = "text" placeholder=" MM" NAME = "Month_Date__bEvent__bOccured" SIZE = "2" VALUE = "" MAXLENGTH = "2">
<INPUT TYPE = "text" placeholder=" DD" NAME = "Day_Date__bEvent__bOccured" SIZE = "2" VALUE = "" MAXLENGTH = "2">
<INPUT TYPE = "text" placeholder=" YYYY" NAME = "Year_Date__bEvent__bOccured" SIZE = "4" VALUE = "" MAXLENGTH = "4">
</td><td nowrap>
<select name = "Hour_Date__bEvent__bOccured">
<option value = "">None<option value = "00">0
<option value = "01">1
<option value = "02">2
<option value = "03">3
<option value = "04">4
<option value = "05">5
<option value = "06">6
<option value = "07">7
<option value = "08">8
<option value = "09">9
<option value = "10">10
<option value = "11">11
<option value = "12">12
<option value = "13">13
<option value = "14">14
<option value = "15">15
<option value = "16">16
<option value = "17">17
<option value = "18">18
<option value = "19">19
<option value = "20">20
<option value = "21">21
<option value = "22">22
<option value = "23">23
</select> : <select name = "Minute_Date__bEvent__bOccured">
<option value = "">None<option value = "00">00
<option value = "05">05
<option value = "10">10
<option value = "15">15
<option value = "20">20
<option value = "25">25
<option value = "30">30
<option value = "35">35
<option value = "40">40
<option value = "45">45
<option value = "50">50
<option value = "55">55
</select></TH>
</TR>
</TABLE></td>
</tr>
<tr>
<Th align = "left">
Course Name</font>
</th>
<td><INPUT placeholder="If realted to a course." NAME="Course__bName" SIZE="30" VALUE=""><BR></td>
</tr>
<tr>
<Th align = "left">
Name of Individual</font>
</th>
<td><INPUT placeholder="If related to an individual" NAME="Name__bof__bIndividual" SIZE="30" VALUE=""><BR></td>
</TD>
</tr>
<Th align = "left">
Confidentiality</font>
</th>
<td><SELECT NAME="Confidentiality">
<OPTION VALUE ="No Choice" >No Choice</OPTION>
<OPTION VALUE ="You may use my name" >You may use my name</OPTION>
<OPTION VALUE ="You may use my name but only after the end of term" >You may use my name but only after the end of term</OPTION>
<OPTION VALUE ="Do not use my name" >Do not use my name</OPTION>
</SELECT></FONT><BR></td>
<Th align = "left">
Referred by</font>
</th>
<td><INPUT NAME="Referred__bby" SIZE="20" VALUE=""><BR></td>
</TD>
</TR>
<TR>