<link href="//netdna.bootstrapcdn.com/bootstrap/3.2.0/css/bootstrap.min.css" rel="stylesheet" id="bootstrap-css"> <script src="//netdna.bootstrapcdn.com/bootstrap/3.2.0/js/bootstrap.min.js"></script> <script src="//code.jquery.com/jquery-1.11.1.min.js"></script> <!------ Include the above in your HEAD tag ----------> <div class="container"> <form class="form-horizontal"> <fieldset> <!-- Form Name --> <legend>Resource Request Form</legend> <!-- Text input--> <div class="control-group"> <label class="control-label" for="firstName">First Name</label> <div class="controls"> <input id="firstName" name="firstName" type="text" placeholder="" class="input-xlarge" required=""> </div> </div> <!-- Text input--> <div class="control-group"> <label class="control-label" for="lastName">Last Name</label> <div class="controls"> <input id="lastName" name="lastName" type="text" placeholder="" class="input-xlarge" required=""> </div> </div> <!-- Text input--> <div class="control-group"> <label class="control-label" for="firstNameLabHead">First Name Head of Lab</label> <div class="controls"> <input id="firstNameLabHead" name="firstNameLabHead" type="text" placeholder="" class="input-xlarge" required=""> </div> </div> <!-- Text input--> <div class="control-group"> <label class="control-label" for="lastNameLabHead">Last Name Head of Lab</label> <div class="controls"> <input id="lastNameLabHead" name="lastNameLabHead" type="text" placeholder="" class="input-xlarge" required=""> </div> </div> <!-- Text input--> <div class="control-group"> <label class="control-label" for="emailAddr">Email Address</label> <div class="controls"> <input id="emailAddr" name="emailAddr" type="text" placeholder="" class="input-xlarge" required=""> </div> </div> <!-- Multiple Radios --> <div class="control-group"> <label class="control-label" for="cfgMember">CFG Member?</label> <div class="controls"> <label class="radio" for="cfgMember-0"> <input type="radio" name="cfgMember" id="cfgMember-0" value="Yes" checked="checked"> Yes </label> <label class="radio" for="cfgMember-1"> <input type="radio" name="cfgMember" id="cfgMember-1" value="No"> No </label> </div> </div> <!-- Text input--> <div class="control-group"> <label class="control-label" for="requestInitiationDate">Date when this request is initiated</label> <div class="controls"> <input id="requestInitiationDate" name="requestInitiationDate" type="text" placeholder="" class="input-xlarge"> <p class="help-block">mm/dd/yy</p> </div> </div> <!-- Text input--> <div class="control-group"> <label class="control-label" for="institution">Institution</label> <div class="controls"> <input id="institution" name="institution" type="text" placeholder="" class="input-xlarge"> </div> </div> <!-- Textarea --> <div class="control-group"> <label class="control-label" for="shippingAddress">Shipping address</label> <div class="controls"> <textarea id="shippingAddress" name="shippingAddress"></textarea> </div> </div> <!-- Text input--> <div class="control-group"> <label class="control-label" for="telephoneNumber">Telephone Number</label> <div class="controls"> <input id="telephoneNumber" name="telephoneNumber" type="text" placeholder="" class="input-xlarge"> </div> </div> <!-- Text input--> <div class="control-group"> <label class="control-label" for="comment">Comment</label> <div class="controls"> <input id="comment" name="comment" type="text" placeholder="" class="input-xlarge"> </div> </div> <!-- Select Basic --> <div class="control-group"> <label class="control-label" for="core">Core</label> <div class="controls"> <select id="core" name="core" class="input-xlarge"> <option>--SELECT--</option> <option>Glycans/antibodies/enzymes</option> <option>Glycan array screening</option> </select> </div> </div> <!-- Select Basic --> <div class="control-group"> <label class="control-label" for="resourceType">Resource Type</label> <div class="controls"> <select id="resourceType" name="resourceType" class="input-xlarge"> <option>Option one</option> <option>Option two</option> </select> </div> </div> <!-- Text input--> <div class="control-group"> <label class="control-label" for="requestedMaterial">Material(s) requested</label> <div class="controls"> <input id="requestedMaterial" name="requestedMaterial" type="text" placeholder="" class="input-xlarge"> <p class="help-block">for reagent bank numbers</p> </div> </div> <!-- Text input--> <div class="control-group"> <label class="control-label" for="amountRequested">Amount Requested and Unit</label> <div class="controls"> <input id="amountRequested" name="amountRequested" type="text" placeholder="" class="input-xlarge"> </div> </div> <!-- Text input--> <div class="control-group"> <label class="control-label" for="gbpSampleDateSent">For Glycan Array Screening, date that your GBP samples will be sent to the core</label> <div class="controls"> <input id="gbpSampleDateSent" name="gbpSampleDateSent" type="text" placeholder="" class="input-xlarge"> <p class="help-block">mm/dd/yy</p> </div> </div> <!-- Textarea --> <div class="control-group"> <label class="control-label" for="experimentDescription">Please provide sufficient description of the proposed experiment and its rationale to allow evaluation of the need for the resource requested</label> <div class="controls"> <textarea id="experimentDescription" name="experimentDescription"></textarea> </div> </div> <!-- Select Basic --> <div class="control-group"> <label class="control-label" for="withinScopeOfCfg">Within Scope of Consortium</label> <div class="controls"> <select id="withinScopeOfCfg" name="withinScopeOfCfg" class="input-xlarge"> <option>Yes</option> <option>No</option> </select> </div> </div> <!-- Text input--> <div class="control-group"> <label class="control-label" for="responsiblePerson">If yes, please indicate the person responsible for depositing data to the consortium DB</label> <div class="controls"> <input id="responsiblePerson" name="responsiblePerson" type="text" placeholder="" class="input-xlarge"> </div> </div> <!-- Textarea --> <div class="control-group"> <label class="control-label" for="additionalSampleInfo">Additional sample information for materials being for glycan array screening (e.g. how will the GBP be labeled for detection on the glycan array)</label> <div class="controls"> <textarea id="additionalSampleInfo" name="additionalSampleInfo"></textarea> </div> </div> <!-- Multiple Checkboxes --> <div class="control-group"> <label class="control-label" for="objective">Objective(s) of experiments using these resources (check all that apply)</label> <div class="controls"> <label class="checkbox" for="objective-0"> <input type="checkbox" name="objective" id="objective-0" value="1: Define the specificity and affinity for carbohydrate ligands"> 1: Define the specificity and affinity for carbohydrate ligands </label> <label class="checkbox" for="objective-1"> <input type="checkbox" name="objective" id="objective-1" value="2: Establish the cell types involved in communication"> 2: Establish the cell types involved in communication </label> <label class="checkbox" for="objective-2"> <input type="checkbox" name="objective" id="objective-2" value="3: Identify the ligand(s) that mediate GBP binding"> 3: Identify the ligand(s) that mediate GBP binding </label> <label class="checkbox" for="objective-3"> <input type="checkbox" name="objective" id="objective-3" value="4: Determine how GBP-ligand interactions mediate cell communication"> 4: Determine how GBP-ligand interactions mediate cell communication </label> <label class="checkbox" for="objective-4"> <input type="checkbox" name="objective" id="objective-4" value="5: Determine the structures of selected GBPs"> 5: Determine the structures of selected GBPs </label> <label class="checkbox" for="objective-5"> <input type="checkbox" name="objective" id="objective-5" value="6: Identify the glycosyltransferases that synthesize carbohydrate ligand(s)"> 6: Identify the glycosyltransferases that synthesize carbohydrate ligand(s) </label> <label class="checkbox" for="objective-6"> <input type="checkbox" name="objective" id="objective-6" value="7: Determine whether regulation of glycosylation modulates GBP function"> 7: Determine whether regulation of glycosylation modulates GBP function </label> </div> </div> </fieldset> </form> </div>