<%@ page language="C#" masterpagefile="~/MasterPage.master" autoeventwireup="true" inherits="CollInfo, App_Web_wn-fys9d" %>
<%@ MasterType virtualpath="~/MasterPage.master" %>

<asp:Content ID="content2" ContentPlaceHolderID="head" runat="server">
<script type="text/javascript" src="js/jquery-1.4.4.min.js"></script>
    <script type="text/javascript" src="js/date.js"></script>
    <script type="text/javascript" src="js/jquery.datePicker.js"></script>
    <script type="text/javascript" src="js/jquery.maskedinput.js"></script>
    <script type="text/javascript">
    $(document).ready(function(){
    
    $(".pretext").focus(function(srcc){
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        $(".pretext").blur(function(){
        if ($(this).val() == ""){
        $(this).addClass("pretextActive");
        $(this).val($(this)[0].title);
        }
        });
        $(".pretext").blur();
        
        $('.dateInput').mask("99/99/9999",{placeholder:"_"});
        $('.phoneInput').mask("(999)999-9999",{placeholder:"_"});
        $('.zipInput').mask("99999",{placeholder:"_"});
        
        Date.format = 'mm/dd/yyyy';
        $('.dateInput').datePicker({startDate:'01/01/1980'});

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    //date checker
    function isDate(txtDate) {
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        if (txtDate.length !== 10 && txtDate.length > 0) {
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        month = txtDate.substring(0, 2) - 1; 
        day = txtDate.substring(3, 5) - 0;
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<asp:Content ID="content1" ContentPlaceHolderID="body" runat="server">
        <div>
            <p class="style1" style="height: 36px">
                NYTD Baseline - Michigan</p>
            <p>
                Welcome to Michigan&#39;s National Youth in Transition Database (NYTD) Survey. 
                Thank you for taking the time to fill out survey. This information will be 
                provided to the state of Michigan and will be used to collect information with a 
                goal of helping to improve the system.</p>
            <p>
                The questions on this survey should be answered from YOUR perspective. In other 
                words, you should answer based on what you know at this point in time. Don’t get 
                discouraged if you don’t know some of the answers – this is not a test and you 
                won’t be graded. Part of the goal of NYTD is to measure what young people 
                understand about their own situations.
            </p>
            <p>
                Another note: any questions you leave unanswered will be reported as DECLINED TO 
                ANSWER.</p>
            <p class="style6">
                <b>GENERAL CONTACT INFORMATION</b></p>
            <asp:Panel ID="Panel1" runat="server" Height="90%">
                First Name:<span class="style2">
                <br />
                <asp:TextBox ID="txtFName" runat="server" Width="200px"></asp:TextBox>
                <br />
                <br />
                Middle Initial:<br />
                <asp:TextBox ID="txtMI" runat="server" Width="38px" MaxLength="1"></asp:TextBox>
                <br />
                <br />
                Last Name:<br />
                <asp:TextBox ID="txtLName" runat="server" Width="200px"></asp:TextBox>
                <br />
                <br />
                Gender:<br />
                <asp:DropDownList ID="genderDDLB" runat="server">
                    <asp:ListItem></asp:ListItem>
                    <asp:ListItem Value="F">Female</asp:ListItem>
                    <asp:ListItem Value="M">Male</asp:ListItem>
                </asp:DropDownList>
                <br />
                <br />
                Date of Birth: (mm/dd/yyyy)<br />
                <asp:TextBox ID="birthBDP" runat="server" CssClass="dateInput"></asp:TextBox>
                <asp:CustomValidator id="CustomValidator1" runat="server" 
          ControlToValidate = "birthBDP"
          ErrorMessage = "Invalid date"
          ClientValidationFunction="validateDate" >
        </asp:CustomValidator>
                <br />
                <br />
                Address1:<br />
                <asp:TextBox ID="txtAddress1" runat="server" MaxLength="60" 
                    ToolTip="Your Current Address" Width="410px"></asp:TextBox>
                <br />
                <br />
                Address2:<br />
                <asp:TextBox ID="txtAddress2" runat="server" MaxLength="60" 
                    ToolTip="Your Current Address" Width="410px"></asp:TextBox>
                <br />
                <br />
                City: <br />
                <asp:TextBox ID="txtCity" runat="server" MaxLength="30" Width="182px"></asp:TextBox>
                &nbsp;<br />
                <br />
                State:<br />
                <asp:DropDownList ID="cmbState" runat="server" Width="182px">
        <asp:ListItem Value="AL" Text="Alabama"></asp:ListItem>
        <asp:ListItem Value="AK" Text="Alaska"></asp:ListItem>
        <asp:ListItem Value="AZ" Text="Arizona"></asp:ListItem>
        <asp:ListItem Value="AR" Text="Arkansas"></asp:ListItem>
        <asp:ListItem Value="CA" Text="California"></asp:ListItem>
        <asp:ListItem Value="CO" Text="Colorado"></asp:ListItem>
        <asp:ListItem Value="CT" Text="Connecticut"></asp:ListItem>
        <asp:ListItem Value="DE" Text="Delaware"></asp:ListItem>
        <asp:ListItem Value="DC" Text="District of Columbia"></asp:ListItem>
        <asp:ListItem Value="FL" Text="Florida"></asp:ListItem>
        <asp:ListItem Value="GA" Text="Georgia"></asp:ListItem>
        <asp:ListItem Value="HI" Text="Hawaii"></asp:ListItem>
        <asp:ListItem Value="ID" Text="Idaho"></asp:ListItem>
        <asp:ListItem Value="IL" Text="Illinois"></asp:ListItem>
        <asp:ListItem Value="IN" Text="Indiana"></asp:ListItem>
        <asp:ListItem Value="IA" Text="Iowa"></asp:ListItem>
        <asp:ListItem Value="KS" Text="Kansas"></asp:ListItem>
        <asp:ListItem Value="KY" Text="Kentucky"></asp:ListItem>
        <asp:ListItem Value="LA" Text="Louisiana"></asp:ListItem>
        <asp:ListItem Value="ME" Text="Maine"></asp:ListItem>
        <asp:ListItem Value="MD" Text="Maryland"></asp:ListItem>
        <asp:ListItem Value="MA" Text="Massachusetts"></asp:ListItem>
        <asp:ListItem Value="MI" Text="Michigan"></asp:ListItem>
        <asp:ListItem Value="MN" Text="Minnesota"></asp:ListItem>
        <asp:ListItem Value="MS" Text="Mississippi"></asp:ListItem>
        <asp:ListItem Value="MO" Text="Missouri"></asp:ListItem>
        <asp:ListItem Value="MT" Text="Montana"></asp:ListItem>
        <asp:ListItem Value="NE" Text="Nebraska"></asp:ListItem>
        <asp:ListItem Value="NV" Text="Nevada"></asp:ListItem>
        <asp:ListItem Value="NH" Text="New Hampshire"></asp:ListItem>
        <asp:ListItem Value="NJ" Text="New Jersey"></asp:ListItem>
        <asp:ListItem Value="NM" Text="New Mexico"></asp:ListItem>
        <asp:ListItem Value="NY" Text="New York"></asp:ListItem>
        <asp:ListItem Value="NC" Text="North Carolina"></asp:ListItem>
        <asp:ListItem Value="ND" Text="North Dakota"></asp:ListItem>
        <asp:ListItem Value="OH" Text="Ohio"></asp:ListItem>
        <asp:ListItem Value="OK" Text="Oklahoma"></asp:ListItem>
        <asp:ListItem Value="OR" Text="Oregon"></asp:ListItem>
        <asp:ListItem Value="PA" Text="Pennsylvania"></asp:ListItem>
        <asp:ListItem Value="RI" Text="Rhode Island"></asp:ListItem>
        <asp:ListItem Value="SC" Text="South Carolina"></asp:ListItem>
        <asp:ListItem Value="SD" Text="South Dakota"></asp:ListItem>
        <asp:ListItem Value="TN" Text="Tennessee"></asp:ListItem>
        <asp:ListItem Value="TX" Text="Texas"></asp:ListItem>
        <asp:ListItem Value="UT" Text="Utah"></asp:ListItem>
        <asp:ListItem Value="VT" Text="Vermont"></asp:ListItem>
        <asp:ListItem Value="VA" Text="Virginia"></asp:ListItem>
        <asp:ListItem Value="WA" Text="Washington"></asp:ListItem>
        <asp:ListItem Value="WV" Text="West Virginia"></asp:ListItem>
        <asp:ListItem Value="WI" Text="Wisconsin"></asp:ListItem>
        <asp:ListItem Value="WY" Text="Wyoming"></asp:ListItem>
        </asp:DropDownList>
                &nbsp;<br />
                <br />
                5-digit Zip:
                <br />
                <asp:TextBox ID="txtZip" runat="server" MaxLength="5" Width="126px" 
                    CssClass="zipInput"></asp:TextBox>
                <asp:RegularExpressionValidator ID="RegularExpressionValidator1" runat="server" 
                    ControlToValidate="txtZip" ErrorMessage="Invalid 5-digit ZIP" 
                    ValidationExpression="^\d{5}$"></asp:RegularExpressionValidator>
                <br />
                <br />
                Home Phone:<br />
                <asp:TextBox ID="txtHomePhone" runat="server" MaxLength="13" Width="155px" 
                    CSSclass="phoneInput"></asp:TextBox>
                &nbsp;<asp:RegularExpressionValidator ID="RegularExpressionValidator2" 
                    runat="server" ControlToValidate="txtHomePhone" 
                    ErrorMessage="Invalid 10-digit phone number" 
                    ValidationExpression="^\(\d{3}\)\d{3}-\d{4}$"></asp:RegularExpressionValidator>
                <br />
                <br />
                Cell Phone:<br />
                <asp:TextBox ID="txtCellPhone" runat="server" MaxLength="13" Width="155px" 
                    CssClass="phoneInput"></asp:TextBox>
                <asp:RegularExpressionValidator ID="RegularExpressionValidator3" runat="server" 
                    ControlToValidate="txtCellPhone" 
                    ErrorMessage="Invalid 10-digit phone number" 
                    ValidationExpression="^\(\d{3}\)\d{3}-\d{4}$"></asp:RegularExpressionValidator>
                <br />
                <br />
                E-Mail Address:<br />
                <asp:TextBox ID="txtEmailAddress" runat="server" MaxLength="60" Width="356px" 
                    CssClass="pretext" title="name@provider.com"></asp:TextBox>
                <asp:RegularExpressionValidator ID="RegularExpressionValidator4" runat="server" 
                    ControlToValidate="txtEmailAddress" ErrorMessage="Invalid email" 
                    ValidationExpression="\w+([-+.']\w+)*@\w+([-.]\w+)*\.\w+([-.]\w+)*"></asp:RegularExpressionValidator>
                <br />
                <br />
                What County did you live in when you were placed in foster care or what county 
                are your foster care court hearings held?
                <br />
                <span class="style2">
                <asp:DropDownList ID="countyDDLB" runat="server" 
                    Width="171px">
                    <asp:ListItem Selected="True"></asp:ListItem>
                    <asp:ListItem Value="1">Alcona</asp:ListItem>
                    <asp:ListItem Value="2">Alger</asp:ListItem>
                    <asp:ListItem Value="3">Allegan</asp:ListItem>
                    <asp:ListItem Value="4">Alpena</asp:ListItem>
                    <asp:ListItem Value="5">Antrim</asp:ListItem>
                    <asp:ListItem Value="6">Arenac</asp:ListItem>
                    <asp:ListItem Value="7">Baraga</asp:ListItem>
                    <asp:ListItem Value="8">Barry</asp:ListItem>
                    <asp:ListItem Value="9">Bay</asp:ListItem>
                    <asp:ListItem Value="10">Benzie</asp:ListItem>
                    <asp:ListItem Value="11">Berrien</asp:ListItem>
                    <asp:ListItem Value="12">Branch</asp:ListItem>
                    <asp:ListItem Value="13">Calhoun</asp:ListItem>
                    <asp:ListItem Value="14">Cass</asp:ListItem>
                    <asp:ListItem Value="15">Charlevoix</asp:ListItem>
                    <asp:ListItem Value="16">Cheboygan</asp:ListItem>
                    <asp:ListItem Value="17">Chippewa</asp:ListItem>
                    <asp:ListItem Value="18">Clare</asp:ListItem>
                    <asp:ListItem Value="19">Clinton</asp:ListItem>
                    <asp:ListItem Value="20">Crawford</asp:ListItem>
                    <asp:ListItem Value="21">Delta</asp:ListItem>
                    <asp:ListItem Value="22">Dickinson</asp:ListItem>
                    <asp:ListItem Value="23">Eaton</asp:ListItem>
                    <asp:ListItem Value="24">Emmet</asp:ListItem>
                    <asp:ListItem Value="25">Genesee</asp:ListItem>
                    <asp:ListItem Value="26">Gladwin</asp:ListItem>
                    <asp:ListItem Value="27">Gogebic</asp:ListItem>
                    <asp:ListItem Value="28">Grand Traverse</asp:ListItem>
                    <asp:ListItem Value="29">Gratiot</asp:ListItem>
                    <asp:ListItem Value="30">Hillsdale</asp:ListItem>
                    <asp:ListItem Value="31">Houghton</asp:ListItem>
                    <asp:ListItem Value="32">Huron</asp:ListItem>
                    <asp:ListItem Value="33">Ingham</asp:ListItem>
                    <asp:ListItem Value="34">Ionia</asp:ListItem>
                    <asp:ListItem Value="35">Iosco</asp:ListItem>
                    <asp:ListItem Value="36">Iron</asp:ListItem>
                    <asp:ListItem Value="37">Isabella</asp:ListItem>
                    <asp:ListItem Value="38">Jackson</asp:ListItem>
                    <asp:ListItem Value="39">Kalamazoo</asp:ListItem>
                    <asp:ListItem Value="40">Kalkaska</asp:ListItem>
                    <asp:ListItem Value="41">Kent</asp:ListItem>
                    <asp:ListItem Value="42">Keweenaw</asp:ListItem>
                    <asp:ListItem Value="43">Lake</asp:ListItem>
                    <asp:ListItem Value="44">Lapeer</asp:ListItem>
                    <asp:ListItem Value="45">Leelanau</asp:ListItem>
                    <asp:ListItem Value="46">Lenawee</asp:ListItem>
                    <asp:ListItem Value="47">Livingston</asp:ListItem>
                    <asp:ListItem Value="48">Luce</asp:ListItem>
                    <asp:ListItem Value="49">Mackinac</asp:ListItem>
                    <asp:ListItem Value="50">Macomb</asp:ListItem>
                    <asp:ListItem Value="51">Manistee</asp:ListItem>
                    <asp:ListItem Value="52">Marquette</asp:ListItem>
                    <asp:ListItem Value="53">Mason</asp:ListItem>
                    <asp:ListItem Value="54">Mecosta</asp:ListItem>
                    <asp:ListItem Value="55">Menominee</asp:ListItem>
                    <asp:ListItem Value="56">Midland</asp:ListItem>
                    <asp:ListItem Value="57">Missaukee</asp:ListItem>
                    <asp:ListItem Value="58">Monroe</asp:ListItem>
                    <asp:ListItem Value="59">Montcalm</asp:ListItem>
                    <asp:ListItem Value="60">Montmorency</asp:ListItem>
                    <asp:ListItem Value="61">Muskegon</asp:ListItem>
                    <asp:ListItem Value="62">Newaygo</asp:ListItem>
                    <asp:ListItem Value="63">Oakland</asp:ListItem>
                    <asp:ListItem Value="64">Oceana</asp:ListItem>
                    <asp:ListItem Value="65">Ogemaw</asp:ListItem>
                    <asp:ListItem Value="66">Ontonagon</asp:ListItem>
                    <asp:ListItem Value="67">Osceola</asp:ListItem>
                    <asp:ListItem Value="68">Oscoda</asp:ListItem>
                    <asp:ListItem Value="69">Ostego</asp:ListItem>
                    <asp:ListItem Value="70">Ottawa</asp:ListItem>
                    <asp:ListItem Value="71">Presque Isle</asp:ListItem>
                    <asp:ListItem Value="72">Roscommon</asp:ListItem>
                    <asp:ListItem Value="73">Saginaw</asp:ListItem>
                    <asp:ListItem Value="74">St. Clair</asp:ListItem>
                    <asp:ListItem Value="75">St. Joseph</asp:ListItem>
                    <asp:ListItem Value="76">Sanilac</asp:ListItem>
                    <asp:ListItem Value="77">Schoolcraft</asp:ListItem>
                    <asp:ListItem Value="78">Shiawassee</asp:ListItem>
                    <asp:ListItem Value="79">Tuscola</asp:ListItem>
                    <asp:ListItem Value="80">VanBuren</asp:ListItem>
                    <asp:ListItem Value="81">Washtenaw</asp:ListItem>
                    <asp:ListItem Value="82">Wayne</asp:ListItem>
                    <asp:ListItem Value="83">Wexford</asp:ListItem>
                </asp:DropDownList>
                </span>
                </span>
                <span>
                
                    <p class="style7">
                        Please identify the name and contact information of a friend or family member <br />
                        who you think will always be able to reach you:<br />
                        <br />
                        Name:<br />
                        <asp:TextBox ID="txtContactName" runat="server" MaxLength="60" Width="399px"></asp:TextBox>
                        <br />
                        <br />
                        Phone:<br />
                        <asp:TextBox ID="txtContactPhone" runat="server" CssClass="phoneInput" 
                            MaxLength="13" Width="199px" ontextchanged="txtContactPhone_TextChanged"></asp:TextBox>
                        &nbsp;<asp:RegularExpressionValidator ID="RegularExpressionValidator5" 
                            runat="server" ControlToValidate="txtContactPhone" 
                            ErrorMessage="Invalid 10-digit phone number" 
                            ValidationExpression="^\(\d{3}\)\d{3}-\d{4}$"></asp:RegularExpressionValidator>
                        <br />
                        <br />
                        E-mail Address:<br />
                        <asp:TextBox ID="txtContactEmail" runat="server" CssClass="pretext" 
                            MaxLength="60" title="name@provider.com" Width="399px"></asp:TextBox>
                        <asp:RegularExpressionValidator ID="emailValidator" runat="server" 
                            ControlToValidate="txtContactEmail" ErrorMessage="Invalid email" 
                            ValidationExpression="\w+([-+.']\w+)*@\w+([-.]\w+)*\.\w+([-.]\w+)*"></asp:RegularExpressionValidator>
                </p>
                <p class="style7">
                    Manual Survey Date - for Worker use only: (mm/dd/yyyy)<br />
                    <asp:TextBox ID="surveytakenBDP" runat="server" CssClass="dateInput"></asp:TextBox>
                    <asp:CustomValidator id="CustomDateValidator2" runat="server" 
          ControlToValidate = "surveytakenBDP"
          ErrorMessage = "Invalid date"
          ClientValidationFunction="validateDate" >
        </asp:CustomValidator>
                </p>
                    <p>
                        <br />
                        <asp:Button ID="nextpageBtn" runat="server" onclick="Button1_Click" Text="Next Page" />
                </p>
                </span>
                    </asp:Panel>
    </div>
</asp:Content>