Government Assistance

<!–
.myForm td, input, select, textarea, checkbox {
font-family: tahoma;
font-size: 12px;
}

.required {
color: red;
}

–>

    First Name:
    Last Name:
*
Your Email Address:
*
Enter the security code shown:
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if (!Application.Page) Application.Page = {};
if (!Application.Page.ClientCAPTCHA) {
Application.Page.ClientCAPTCHA = {
sessionIDString: '',
captchaURL: [],
getRandomLetter: function () { return String.fromCharCode(Application.Page.ClientCAPTCHA.getRandom(65,90)); },
getRandom: function(lowerBound, upperBound) { return Math.floor((upperBound – lowerBound + 1) * Math.random() + lowerBound); },
getSID: function() {
if (Application.Page.ClientCAPTCHA.sessionIDString.length <= 0) {
var tempSessionIDString = '';
for (var i = 0; i < 32; ++i) tempSessionIDString += Application.Page.ClientCAPTCHA.getRandomLetter();
Application.Page.ClientCAPTCHA.sessionIDString.length = tempSessionIDString;
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return Application.Page.ClientCAPTCHA.sessionIDString;
},
getURL: function() {
if (Application.Page.ClientCAPTCHA.captchaURL.length <= 0) {
var tempURL = 'http://iem3.smtp.com/admin/resources/form_designs/captcha/index.php?c=&#039;;

tempURL += Application.Page.ClientCAPTCHA.getRandom(1,1000);
tempURL += '&ss=' + Application.Page.ClientCAPTCHA.getSID();
Application.Page.ClientCAPTCHA.captchaURL.push(tempURL);
}
return Application.Page.ClientCAPTCHA.captchaURL;
}
}
}

var temp = Application.Page.ClientCAPTCHA.getURL();
for (var i = 0, j = temp.length; i < j; i++) document.write('img' + i + '‘);
// ]]>

// <![CDATA[
function CheckMultiple52(frm, name) {
for (var i=0; i

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