<?xml version="1.0" encoding="UTF-8"?>

<form url="sevisconfirmation.php"
 window="_self"
 method="POST"
 fontname="MS Sans Serif"
 width="750"
 height="464"
 bkcolor="0xFFFFFF"
 outlinecolor="0xFFFFFF"
 fontcolor="0x000000"
 themecolor="0xFFFFFF"
 fontcolor2="#000000"
 bkcolor2="#FFFFFF"
 includeresults="true"
 emailuser="true"
 reqmessage="One or More Fields are Required"
 autoresponse="Thank you for takig time to validate your program with us.">

<hidden
 name="thankyoumessage"
 value="Thank you for taking time to valadate your SEVIS DS-2019."
></hidden>

<hidden
 name="mailto"
 value="sboesmi@ymcanyc.org"
></hidden>

<hidden
 name="subject"
 value="SEVIS Confirmation"
></hidden>

<image
 image="2005c.jpg"
 x="463"
 y="7"
></image>

<textinput
 name="Family Name"
 x="212"
 y="156"
 w="175"
 h="22"
 initvalue=""
 bkcolor="0xFFFFFF"
  fontname="Arial"
  fontcolor="0x000000"
 required="true"
>
</textinput>

<textinput
 name="First Name"
 x="216"
 y="184"
 w="175"
 h="22"
 initvalue=""
 bkcolor="0xFFFFFF"
  fontname="Arial"
  fontcolor="0x000000"
 required="true"
>
</textinput>

<textinput
 name="DS2019 Number"
 x="152"
 y="212"
 w="175"
 h="22"
 initvalue=""
 bkcolor="0xFFFFFF"
  fontname="Arial"
  fontcolor="0x000000"
 required="true"
>
</textinput>

<textinput
 name="Address"
 x="308"
 y="240"
 w="175"
 h="22"
 initvalue=""
 bkcolor="0xFFFFFF"
  fontname="Arial"
  fontcolor="0x000000"
 required="true"
>
</textinput>

<textinput
 name="City"
 x="60"
 y="269"
 w="175"
 h="22"
 initvalue=""
 bkcolor="0xFFFFFF"
  fontname="Arial"
  fontcolor="0x000000"
 required="true"
>
</textinput>

<textinput
 name="State"
 x="289"
 y="269"
 w="33"
 h="22"
 initvalue=""
 bkcolor="0xFFFFFF"
  fontname="Arial"
  fontcolor="0x000000"
 required="true"
>
</textinput>

<textinput
 name="Zip Code"
 x="405"
 y="268"
 w="89"
 h="22"
 initvalue=""
 bkcolor="0xFFFFFF"
  fontname="Arial"
  fontcolor="0x000000"
 required="true"
>
</textinput>

<textinput
 name="E Mail"
 x="132"
 y="300"
 w="445"
 h="22"
 initvalue=""
 bkcolor="0xFFFFFF"
  fontname="Arial"
  fontcolor="0x000000"
 required="true"
 emailbox="true"
>
</textinput>

<textinput
 name="Host Site"
 x="284"
 y="332"
 w="435"
 h="22"
 initvalue=""
 bkcolor="0xFFFFFF"
  fontname="Arial"
  fontcolor="0x000000"
 required="true"
>
</textinput>

<textinput
 name="Supervisors Name"
 x="161"
 y="362"
 w="175"
 h="22"
 initvalue=""
 bkcolor="0xFFFFFF"
 fontbold="bold"
  fontname="Arial"
  fontcolor="0x000000"
 required="true"
>
</textinput>

<textinput
 name="Supervisors Phone Number"
 x="550"
 y="364"
 w="175"
 h="22"
 initvalue=""
 bkcolor="0xFFFFFF"
 fontbold="bold"
  fontname="Arial"
  fontcolor="0x000000"
 required="true"
>
</textinput>

<submitbutton
 name="Submit Button 1"
 x="368"
 y="416"
 w="89"
 h="19"
 label="Submit"
 fontname="Verdana"
 fontcolor="0x000000"
 image="magenta.jpg"
 fontbold="bold"
  fontsize="16"
></submitbutton>

<label
 name="My Text 1"
 x="120"
 y="76"
 w="238"
 h="29"
 text="SEVIS Confirmation"
  fontname="Verdana"
  fontcolor="0x000000"
  fontsize="23"
></label>

<label
 name="My Text 2"
 x="20"
 y="164"
 w="192"
 h="16"
 text="Family Name or Surname:"
 fontbold="bold"
  fontname="Verdana"
  fontcolor="0x000000"
  fontsize="13"
></label>

<label
 name="My Text 3"
 x="18"
 y="192"
 w="198"
 h="16"
 text="First Name or Given Name:"
 fontbold="bold"
  fontname="Verdana"
  fontcolor="0x000000"
  fontsize="13"
></label>

<label
 name="My Text 4"
 x="20"
 y="220"
 w="132"
 h="16"
 text="DS-2019 Number:"
 fontbold="bold"
  fontname="Verdana"
  fontcolor="0x000000"
  fontsize="13"
></label>

<label
 name="My Text 5"
 x="336"
 y="216"
 w="162"
 h="16"
 text="N0007891234 Sample"
 fontbold="bold"
  fontname="Verdana"
  fontcolor="0x000000"
  fontsize="13"
></label>

<label
 name="My Text 6"
 x="20"
 y="248"
 w="284"
 h="16"
 text="Your Address where you live in the US:"
 fontbold="bold"
  fontname="Verdana"
  fontcolor="0x000000"
  fontsize="13"
></label>

<label
 name="My Text 7"
 x="492"
 y="248"
 w="180"
 h="16"
 text="NO PO BOX can be used."
 fontbold="bold"
  fontname="Verdana"
  fontcolor="0x000000"
  fontsize="13"
></label>

<label
 name="My Text 8"
 x="20"
 y="275"
 w="38"
 h="16"
 text="City:"
 fontbold="bold"
  fontname="Verdana"
  fontcolor="0x000000"
  fontsize="13"
></label>

<label
 name="My Text 9"
 x="241"
 y="276"
 w="48"
 h="16"
 text="State:"
 fontbold="bold"
  fontname="Verdana"
  fontcolor="0x000000"
  fontsize="13"
></label>

<label
 name="My Text 10"
 x="332"
 y="276"
 w="72"
 h="16"
 text="Zip Code:"
 fontbold="bold"
  fontname="Verdana"
  fontcolor="0x000000"
  fontsize="13"
></label>

<label
 name="My Text 11"
 x="16"
 y="308"
 w="114"
 h="16"
 text="E Mail Address:"
 fontbold="bold"
  fontname="Verdana"
  fontcolor="0x000000"
  fontsize="13"
></label>

<label
 name="My Text 12"
 x="16"
 y="340"
 w="266"
 h="16"
 text="Company or Camp where you  work:"
 fontbold="bold"
  fontname="Verdana"
  fontcolor="0x000000"
  fontsize="13"
></label>

<label
 name="My Text 13"
 x="16"
 y="368"
 w="145"
 h="16"
 text="Supervisor's Name:"
 fontbold="bold"
  fontname="Verdana"
  fontcolor="0x000000"
  fontsize="13"
></label>

<label
 name="My Text 14"
 x="340"
 y="369"
 w="209"
 h="16"
 text="Supervisor's Phone Number:"
 fontbold="bold"
  fontname="Verdana"
  fontcolor="0x000000"
  fontsize="13"
></label>

<label
 name="My Text 15"
 x="220"
 y="392"
 w="161"
 h="23"
 text="Thank You......"
 fontbold="bold"
  fontname="Verdana"
  fontcolor="0x000000"
  fontsize="19"
></label>

<label
 name="My Text 16"
 x="252"
 y="444"
 w="294"
 h="13"
 text="If it does not Submit you are missing a field."
 fontbold="bold"
  fontname="Verdana"
  fontcolor="0xFF0000"
  fontsize="11"
></label>

</form>
