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<script src="//code.jquery.com/jquery-1.11.1.min.js"></script>
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<!doctype html>
<html>
<head>
<link rel="stylesheet" type="text/css" href="https://maxcdn.bootstrapcdn.com/bootstrap/3.3.5/css/bootstrap.min.css">
<link rel="stylesheet" type="text/css" href="test.css"
</head>
<body>
<form class="form-horizontal">
<fieldset>
<!-- Form Name -->
<legend>Program Proposal Form</legend>
<!-- Text input-->
<div class="form-group">
<label class="col-md-4 control-label" for="primary-contact">Primary Contact Number</label>
<div class="col-md-2">
<input id="primary-contact" name="primary-contact" type="text" placeholder="(203)-(###)-(####)" class="form-control input-md">
</div>
</div>
<!-- Select Basic -->
<div class="form-group">
<label class="col-md-4 control-label" for="program-hall-director_gradintern">Hall Director / Grad Intern</label>
<div class="col-md-2">
<select id="program-hall-director_gradintern" name="program-hall-director_gradintern" class="form-control">
<option value="Adam Bonet">Adam Bonet</option>
<option value="Brooke Suprenant">Brooke Suprenant</option>
<option value="Cristalyn Vargas">Cristalyn Vargas</option>
<option value="Elizabeth Dishian">Elizabeth Dishian</option>
<option value="Jahkahli Johnson">Jahkahli Johnson</option>
<option value="Jason Rizk">Jason Rizk</option>
<option value="Kaitlyn Hoffman">Kaitlyn Hoffman</option>
<option value="Kaitlyn Cody">Kaitlyn Cody</option>
<option value="Meurice Redding">Meurice Redding</option>
<option value="Nick Gleifert">Nick Gleifert</option>
</select>
</div>
</div>
<!-- Select Basic -->
<div class="form-group">
<label class="col-md-4 control-label" for="program-type">Program Type</label>
<div class="col-md-3">
<select id="program-type" name="program-type" class="form-control">
<option value="Academic/Professional Success">Academic/Professional Success</option>
<option value="All Hall">All Hall</option>
<option value="Civic Engagement">Civic Engagement</option>
<option value="Common Read">Common Read</option>
<option value="Floor Meetings">Floor Meetings</option>
<option value="Hall Council">Hall Council</option>
<option value="Life Skills">Life Skills</option>
<option value="LLC-Sustainability">LLC-Sustainability</option>
<option value="LLC-First Generation">LLC-First Generation</option>
<option value="LLC-Transfer">LLC-Transfer</option>
<option value="LLC-Honors">LLC-Honors</option>
<option value="LLC-International">LLC-International</option>
<option value="Social">Social</option>
<option value="Social Justice">Social Justice</option>
<option value="Spontaneous">Spontaneous</option>
<option value="Weekend">Weekend</option>
<option value="Other">Other</option>
</select>
</div>
</div>
<!-- Select Basic -->
<div class="form-group">
<label class="col-md-4 control-label" for="program-delivery">Program Delivery</label>
<div class="col-md-2">
<select id="program-delivery" name="program-delivery" class="form-control">
<option value="1">Community Based</option>
<option value="2">Tabling</option>
<option value="">Door To Door</option>
</select>
</div>
</div>
<!-- Text input-->
<div class="form-group">
<label class="col-md-4 control-label" for="program-title">Title of Program</label>
<div class="col-md-5">
<input id="program-title" name="program-title" type="text" placeholder="" class="form-control input-md">
</div>
</div>
<!-- Select Basic -->
<div class="form-group inline">
<label class="col-md-4 control-label" for="program-date-month">Program Date</label>
<div class="col-md-2 inline">
<select id="program-date-month" name="program-date-month" class="form-control">
<option value="January">January</option>
<option value="February">February</option>
<option value="March">March</option>
<option value="April">April</option>
<option value="May">May</option>
<option value="June">June</option>
<option value="July">July</option>
<option value="August">August</option>
<option value="September">September</option>
<option value="October">October</option>
<option value="November">November</option>
<option value="December">December</option>
</select>
</div>
<label class="control-label" for="program-date-day"></label>
<div class="col-md-1 ">
<select id="program-date-day" name="program-date-day" class="form-control">
<option value="1">1</option>
<option value="2">2</option>
<option value="3">3</option>
<option value="4">4</option>
<option value="5">5</option>
<option value="6">6</option>
<option value="7">7</option>
<option value="8">8</option>
<option value="9">9</option>
<option value="10">10</option>
<option value="11">11</option>
<option value="12">12</option>
<option value="13">13</option>
<option value="14">14</option>
<option value="15">15</option>
<option value="16">16</option>
<option value="17">17</option>
<option value="18">18</option>
<option value="19">19</option>
<option value="20">20</option>
<option value="21">21</option>
<option value="22">22</option>
<option value="23">23</option>
<option value="24">24</option>
<option value="25">25</option>
<option value="26">26</option>
<option value="27">27</option>
<option value="28">28</option>
<option value="29">29</option>
<option value="30">30</option>
<option value="31">31</option>
</select>
</div>
<label class="control-label" for="program-date-year"></label>
<div class="col-md-2">
<select id="program-date-year" name="program-date-year" class="form-control">
<option value="2015">2015</option>
</select>
</div>
</div>
<!-- Select Basic -->
<div class="form-group inline">
<label class="col-md-4 control-label" for="program-location">Program Time</label>
<div class="col-md-1">
<select id="program-date-hour" name="program-date-hour" class="form-control">
<option value="1">1</option>
<option value="2">2</option>
<option value="3">3</option>
<option value="4">4</option>
<option value="5">5</option>
<option value="6">6</option>
<option value="7">7</option>
<option value="8">8</option>
<option value="9">9</option>
<option value="10">10</option>
<option value="11">11</option>
<option value="12">12</option>
</select>
</div>
<label class="col-xs- control-label" for="program-date-minute"></label>
<div class="col-md-1">
<select id="program-date-minute" name="program-date-minute" class="form-control">
<option value="1">1</option>
<option value="2">2</option>
<option value="3">3</option>
<option value="4">4</option>
<option value="5">5</option>
<option value="6">6</option>
<option value="7">7</option>
<option value="8">8</option>
<option value="9">9</option>
<option value="10">10</option>
<option value="11">11</option>
<option value="12">12</option>
<option value="13">13</option>
<option value="14">14</option>
<option value="15">15</option>
<option value="16">16</option>
<option value="17">17</option>
<option value="18">18</option>
<option value="19">19</option>
<option value="20">20</option>
<option value="21">21</option>
<option value="22">22</option>
<option value="23">23</option>
<option value="24">24</option>
<option value="25">25</option>
<option value="26">26</option>
<option value="27">27</option>
<option value="28">28</option>
<option value="29">29</option>
<option value="30">30</option>
<option value="31">31</option>
<option value="32">32</option>
<option value="33">33</option>
<option value="34">34</option>
<option value="35">35</option>
<option value="36">36</option>
<option value="37">37</option>
<option value="38">38</option>
<option value="39">39</option>
<option value="40">40</option>
<option value="41">41</option>
<option value="42">42</option>
<option value="43">43</option>
<option value="44">44</option>
<option value="45">45</option>
<option value="46">46</option>
<option value="47">47</option>
<option value="48">48</option>
<option value="49">49</option>
<option value="50">50</option>
<option value="51">51</option>
<option value="52">52</option>
<option value="53">53</option>
<option value="54">54</option>
<option value="55">55</option>
<option value="56">56</option>
<option value="57">57</option>
<option value="58">58</option>
<option value="59">59</option>
</select>
</div>
<label class="control-label" for="program-date-am_pm"></label>
<div class="col-md-1">
<select id="program-date-am_pm" name="program-date-am_pm" class="form-control">
<option value="am">AM</option>
<option value="pm">PM</option>
</select>
</div>
</div>
<!-- Select Basic -->
<div class="form-group">
<label class="col-md-4 control-label" for="program-location">Program Location</label>
<div class="col-md-3">
<select id="program-location" name="program-location" class="form-control">
<option value="Brownell">Brownell</option>
<option value="Chase">Chase</option>
<option value="Farnham">Farnham</option>
<option value="Farnham Programimng Space">Farnham Programimng Space</option>
<option value="Hickerson">Hickerson</option>
<option value="Neff">Neff</option>
<option value="North Campus Midrise">North Campus Midrise</option>
<option value="North Campus Townhouse">North Campus Townhouse</option>
<option value="Schwartz">Schwartz</option>
<option value="West">West</option>
<option value="Wilkinson">Wilkinson</option>
</select>
</div>
</div>
<!-- Select Basic -->
<div class="form-group">
<label class="col-md-4 control-label" for="program-department">Program Department</label>
<div class="col-md-3">
<select id="program-department" name="program-department" class="form-control">
<option value="Academic Advisement">Academic Advisement</option>
<option value="Athletic Department">Athletic Department</option>
<option value="Buley Library">Buley Library</option>
<option value="Bursar">Bursar</option>
<option value="Campus Recreation">Campus Recreation</option>
<option value="Center for Adaptive Technology">Center for Adaptive Technology</option>
<option value="Counseling Center">Counseling Center</option>
<option value="D.A.R.C.">D.A.R.C.</option>
<option value="D.R.C.">D.R.C.</option>
<option value="Faculty Involvement">Faculty Involvement</option>
<option value="Financial Aid & Scholarships">Financial Aid & Scholarships</option>
<option value="Fitness Center">Fitness Center</option>
<option value="FYE">FYE</option>
<option value="Health Services">Health Services</option>
<option value="Honors College">Honors College</option>
<option value="Interfaith College">Interfaith College</option>
<option value="Intramurals">Intramurals</option>
<option value="Judicial Affairs">Judicial Affairs</option>
<option value="Men's Initiative">Men's Initiative</option>
<option value="Multicultural Center">Multicultural Center</option>
<option value="OIT Help Desk">OIT Help Desk</option>
<option value="Programs Council">Programs Council</option>
<option value="Service Team">Service Team</option>
<option value="Student Life">Student Life</option>
<option value="Sustainability Office">Sustainability Office</option>
<option value="University Police">University Police</option>
<option value="Veterans Center">Veterans Center</option>
<option value="Wellness Center">Wellness Center</option>
<option value="Women's Center">Women's Center</option>
<option value="Writing Center">Writing Center</option>
<option value="N/A">N/A</option>
</select>
</div>
</div>
<!-- Textarea -->
<div class="form-group">
<label class="col-md-4 control-label" for="program-learning-outcomes"> Learning Outcomes (Max 1000 Char.)</label>
<div class="col-md-4">
<textarea class="form-control" id="program-learning-outcomes" name="program-learning-outcomes"></textarea>
</div>
</div>
<!-- Textarea -->
<div class="form-group">
<label class="col-md-4 control-label" for="program-description">Description (Max 1000 Char.)</label>
<div class="col-md-4">
<textarea class="form-control" id="program-description" name="program-description"></textarea>
</div>
</div>
<!-- Prepended checkbox -->
<div class="form-group col-md-12" style="text-align:center">
<label class="col-md-3 col-md-offset-1 control-label">Funding</label>
<label class="col-md-1 control-label" for="funding-pcard">P-Card</label>
<div class="col-md-2">
<div class="input-group">
<span class="input-group-addon">
<input type="checkbox">
</span>
<input id="funding-pcard" name="funding-pcard" class="form-control" type="text" placeholder="$">
</div>
</div>
<label class="col-md-1 control-label" for="funding-hootloot">Hootloot</label>
<div class="col-md-2">
<div class="input-group">
<span class="input-group-addon">
<input type="checkbox">
</span>
<input id="funding-hootloot" name="funding-hootloot" class="form-control" type="text" placeholder="$">
</div>
</div>
</div>
<div class="form-group">
<label class="col-md-4 control-label" for="pickup-funding-card">Please Select a time which you will be able to pick up your funding card:</label>
<div class="col-md-6">
<label class="radio-inline" for="pickup-funding-card-0">
<input type="radio" name="pickup-funding-card" id="pickup-funding-card-0" value="900am" checked="checked">
9:00 AM
</label>
<label class="radio-inline" for="pickup-funding-card-1">
<input type="radio" name="pickup-funding-card" id="pickup-funding-card-1" value="930am">
9:30 AM
</label>
<label class="radio-inline" for="pickup-funding-card-2">
<input type="radio" name="pickup-funding-card" id="pickup-funding-card-2" value="1000am">
10:00 AM
</label>
<label class="radio-inline" for="pickup-funding-card-3">
<input type="radio" name="pickup-funding-card" id="pickup-funding-card-3" value="300pm">
3:00 PM
</label>
<label class="radio-inline" for="pickup-funding-card-4">
<input type="radio" name="pickup-funding-card" id="pickup-funding-card-4" value="330pm">
3:30 PM
</label>
<label class="radio-inline" for="pickup-funding-card-5">
<input type="radio" name="pickup-funding-card" id="pickup-funding-card-5" value="400pm">
4:00 PM
</label>
</div>
</div>
<h4 style="text-align:center; color:red"> Insert Javascript here to hide unless above boxes are toggled on</h4>
<label class="col-md-12 control-label" style="text-align:center;"for="">Description of what is to be purchased, where it is to be purchased, and the estimated amount:</label>
<!-- Text input-->
<div class="form-group" style="text-align:center">
<label class="col-md-2 control-label center" for="item-to-be-purchased-name">Item Name</label>
<label class="col-md-1 control-label center" for="funding-for-item-cost">Cost</label>
<label class="col-md-4 control-label center" for="funding-for-item-description">Description</label>
<label class="col-md-4 control-label center" for="funding-for-item-store">Tax Exempt Restaurant</label>
<div class="col-md-2 soft-push">
<input id="item-to-be-purchased-name" name="item-to-be-purchased-name" type="text" placeholder="" class="form-control input-md">
</div>
<div class="col-md-1">
<input id="funding-for-item-cost" name="funding-for-item-cost" type="text" placeholder="$" class="form-control input-md">
</div>
<div class="col-md-4">
<input id="funding-for-item-description" name="funding-for-item-description" type="text" placeholder="" class="form-control input-md">
</div>
<div class="col-md-4">
<select id="funding-for-item-store" name="funding-for-item-store" class="form-control">
<option value="Panera Bread - 2100 Dixwell Avenue #27, Hamden, CT">Panera Bread - 2100 Dixwell Avenue #27, Hamden, CT</option>
<option value="Chilis - 2100 Dixwell Avenue, Hamden, CT">Chilis - 2100 Dixwell Avenue, Hamden, CT</option>
<option value="Bruggers Bagles - 1460 Whalley Avenue, New Haven CT">Bruggers Bagles - 1460 Whalley Avenue, New Haven CT</option>
<option value="Zio Francos - 1869 Dixwell Avenue #3,Hamden CT">Zio Francos - 1869 Dixwell Avenue #3,Hamden CT</option>
<option value="Blessings To Go - 898 State Street, New Haven CT">Blessings To Go - 898 State Street, New Haven CT</option>
<option value="Wing Madness - 716 Dixwell Avenue, New Haven CT">Wing Madness - 716 Dixwell Avenue, New Haven CT</option>
<option value="Modern Pizza - 874 State Street, New Haven, CT">Modern Pizza - 874 State Street, New Haven, CT</option>
<option value="Stop and Shop - 150 Whalley Avenue, New Haven CT">Stop and Shop - 150 Whalley Avenue, New Haven CT</option>
<option value="Holiday Cinemas - 970 North Colony Road, Wallingford CT">Holiday Cinemas - 970 North Colony Road, Wallingford CT</option>
<option value="Chens Kitchen - 883 Whalley Avenue, New Haven CT">Chens Kitchen - 883 Whalley Avenue, New Haven CT</option>
<option value="Perfect Party - 2100 Dixwell Avenue, Hamden CT">Perfect Party - 2100 Dixwell Avenue, Hamden CT</option>
<option value="Walmart - 2300 Dixwell Avenue, Hamden CT">Walmart - 2300 Dixwell Avenue, Hamden CT</option>
<option value="Walmart Supercenter - 315 Foxon Blvd, New Haven CT">Walmart Supercenter - 315 Foxon Blvd, New Haven CT</option>
<option value="Jo-Ann Fabric - 2300 Dixwell Avenue, Hamden CT">Jo-Ann Fabric - 2300 Dixwell Avenue, Hamden CT</option>
<option value="B&B Deli - 1440 Dixwell Avenue, Hamden CT">B&B Deli - 1440 Dixwell Avenue, Hamden CT</option>
<option value="Szechuan Delight - 1720 Dixwell Avenue, Hamden CT">Szechuan Delight - 1720 Dixwell Avenue, Hamden CT</option>
<option value="Red Lobster - 320 Universal Drive, North Haven CT">Red Lobster - 320 Universal Drive, North Haven CT</option>
<option value="Home Depot - 1873 Dixwell Avenue, Hamden, CT">Home Depot - 1873 Dixwell Avenue, Hamden, CT</option>
<option value="Sam Ash - 95 Amity Road, New Haven CT">Sam Ash - 95 Amity Road, New Haven CT</option>
<option value="Broadway Pizza - 185 Derby Avenue, New Haven CT">Broadway Pizza - 185 Derby Avenue, New Haven CT</option>
<option value="Pizza Haven - 410 Blake Street, New Haven CT">Pizza Haven - 410 Blake Street, New Haven CT</option>
<option value="Edge of the Woods - 379 Whalley Avenue, New Haven, CT">Edge of the Woods - 379 Whalley Avenue, New Haven, CT</option>
<option value="Westville Pizza - 883 Whalley Avenue, New Haven CT">Westville Pizza - 883 Whalley Avenue, New Haven CT</option>
<option value="Hing Wah - 913 Dixwell Avenue, New Haven CT">Hing Wah - 913 Dixwell Avenue, New Haven CT</option>
<option value="Marco Polo Pizzaria - 55 Crown Street, New Haven CT">Marco Polo Pizzaria - 55 Crown Street, New Haven CT</option>
<option value="Dominos Pizza - 357 Whalley Avenue, New Haven CT">Dominos Pizza - 357 Whalley Avenue, New Haven CT</option>
<option value="Subway - 865 Whalley Avenue, New Haven CT">Subway - 865 Whalley Avenue, New Haven CT</option>
<option value="Subway - 1315 Dixwell Avenue, Hamden CT">Subway - 1315 Dixwell Avenue, Hamden CT</option>
<option value="Dunkin Donuts - 864 Whalley Avenue, New Haven CT">Dunkin Donuts - 864 Whalley Avenue, New Haven CT</option>
<option value="More Than Pizza - 533 Whalley Avenue, New Haven CT">More Than Pizza - 533 Whalley Avenue, New Haven CT</option>
<option value="Stop and Shop - 1245 Dixwell Avenue, Hamden CT">Stop and Shop - 1245 Dixwell Avenue, Hamden CT</option>
<option value="PaPa Johns - 125 Whalley Avenue, New Haven CT">PaPa Johns - 125 Whalley Avenue, New Haven CT</option>
<option value="Dunkin Donuts - 295 Blake Street, New Haven CT">Dunkin Donuts - 295 Blake Street, New Haven CT</option>
<option value="Party City - 2165 Dixwell Avenue, Hamden CT">Party City - 2165 Dixwell Avenue, Hamden CT</option>
<option value="AAA Pizza - 383 Whalley Avenue, New Haven CT">AAA Pizza - 383 Whalley Avenue, New Haven CT</option>
<option value="Little Caesars Pizza - 1245 Dixwell Avenue, Hamden CT">Little Caesars Pizza - 1245 Dixwell Avenue, Hamden CT</option>
<option value="SoCos Bar and Restaurant - 50 Fitch Street, New Haven CT">SoCos Bar and Restaurant - 50 Fitch Street, New Haven CT</option>
<option value="Taco Bell - 2320 Dixwell Ave, Hamden CT">Taco Bell - 2320 Dixwell Ave, Hamden CT</option>
<option value="CVS - 2045 Dixwell Avenue, Hamden CT">CVS - 2045 Dixwell Avenue, Hamden CT</option>
<option value="CVS - 1168 Whalley Avenue, New Haven, CT">CVS - 1168 Whalley Avenue, New Haven, CT</option>
<option value="Three Brothers - 1038 Dixwell Avenue, Hamden, CT">Three Brothers - 1038 Dixwell Avenue, Hamden, CT</option>
<option value="Elis on Whitney - 2392 Whitney Avenue, Hamden CT">Elis on Whitney - 2392 Whitney Avenue, Hamden CT</option>
<option value="Sam's Club - 2 Boston Post Road, Orange CT">Sam's Club - 2 Boston Post Road, Orange CT</option>
</select>
</div>
</div>
<!-- Multiple Radios (inline) -->
<div class="form-group">
<label class="col-md-4 control-label" for="require-speaker-status">Will you require a speaker/presenter for this program?</label>
<div class="col-md-4">
<label class="radio-inline" for="require-speaker-status-0">
<input type="radio" name="require-speaker-status" id="require-speaker-status-0" value="yes" checked="checked">
Yes
</label>
<label class="radio-inline" for="require-speaker-status-1">
<input type="radio" name="require-speaker-status" id="require-speaker-status-1" value="no">
No
</label>
</div>
</div>
<!-- Multiple Radios (inline) -->
<div class="form-group">
<label class="col-md-4 control-label" for="contacted-speaker-status">Have you made contact with a Speaker/Presenter?</label>
<div class="col-md-4">
<label class="radio-inline" for="contacted-speaker-status-0">
<input type="radio" name="contacted-speaker-status" id="contacted-speaker-status-0" value="yes" checked="checked">
Yes
</label>
<label class="radio-inline" for="contacted-speaker-status-1">
<input type="radio" name="contacted-speaker-status" id="contacted-speaker-status-1" value="no">
No
</label>
</div>
</div>
<div class="form-group">
<label class="col-md-4 control-label center" for="speaker-name">Name</label>
<label class="col-md-2 control-label center" for="speaker-title">Title</label>
<label class="col-md-6 control-label left-push" for="speaker-phone1">Phone</label>
<div class="col-md-12">
<div class="col-md-4">
<input id="speaker-name" name="speaker-name" type="text" placeholder="" class="form-control input-md">
</div>
<div class="col-md-2 ">
<input id="speaker-title" name="speaker-title" type="text" placeholder="" class="form-control input-md">
</div>
<div class="col-md-1 col-md-offset-1">
<input id="speaker-phone1" name="speaker-phone1" type="text" placeholder="" class="form-control input-md">
</div>
<div class="col-md-1">
<input id="speaker-phone2" name="speaker-phone2" type="text" placeholder="" class="form-control input-md">
</div>
<div class="col-md-1">
<input id="speaker-phone3" name="speaker-phone3" type="text" placeholder="" class="form-control input-md">
</div>
</div>
</div>
<label class="col-md-12 control-label" style="text-align:center; color:red"for=""><h4>Additional Staff #1</h4></label>
<!-- Text input-->
<div class="form-group">
<label class="col-md-1 soft-push control-label" for="additional-staff-fname">First Name</label>
<div class="col-md-3">
<input id="additional-staff-fname" name="additional-staff-fname" type="text" placeholder="" class="form-control input-md">
</div>
<label class="col-md-1 control-label" for="additional-staff-lname">Last Name</label>
<div class="col-md-3">
<input id="additional-staff-lname" name="additional-staff-lname" type="text" placeholder="" class="form-control input-md">
</div>
</div>
<!-- Select Basic -->
<div class="form-group">
<label class="col-md-1 control-label soft-push" for="additional-staff-building">Building</label>
<div class="col-md-3">
<select id="additional-staff-building" name="additional-staff-building" class="form-control">
<option value="Brownell">Brownell</option>
<option value="Chase">Chase</option>
<option value="Farnham">Farnham</option>
<option value="Farnham Programimng Space">Farnham Programimng Space</option>
<option value="Hickerson">Hickerson</option>
<option value="Neff">Neff</option>
<option value="North Campus Midrise">North Campus Midrise</option>
<option value="North Campus Townhouse">North Campus Townhouse</option>
<option value="Schwartz">Schwartz</option>
<option value="West">West</option>
<option value="Wilkinson">Wilkinson</option>
</select>
</div>
<label class="col-md-1 control-label" for="additional-staff-email">SCSU Email</label>
<div class="col-md-4">
<input id="additional-staff-email" name="additional-staff-email" type="text" placeholder="@owls.southernct.edu" class="form-control input-md">
</div>
</div>
<!-- Text input-->
<div class="form-group">
<label class="col-md-1 control-label soft-push" for="">Cell Phone</label>
<div class="col-md-1">
<input id="speaker-phone1" name="speaker-phone1" type="text" placeholder="" class="form-control input-md">
</div>
<div class="col-md-1">
<input id="speaker-phone2" name="speaker-phone2" type="text" placeholder="" class="form-control input-md">
</div>
<div class="col-md-1">
<input id="speaker-phone3" name="speaker-phone3" type="text" placeholder="" class="form-control input-md">
</div>
</div>
<label class="col-md-12 control-label" style="text-align:center; color:red"for=""><h4>Add Additional staff (insert javascript activated stuff here)</h4></label>
<!-- Multiple Checkboxes (inline) -->
<div class="form-group">
<label class="col-md-4 control-label" for="portable-projector-request">Is a portable projector needed?</label>
<div class="col-md-4">
<label class="checkbox-inline" for="portable-projector-request-0">
<input type="checkbox" name="portable-projector-request" id="portable-projector-request-0" value="yes">
Yes
</label>
<label class="checkbox-inline" for="portable-projector-request-1">
<input type="checkbox" name="portable-projector-request" id="portable-projector-request-1" value="no">
No
</label>
</div>
</div>
<!-- Textarea -->
<div class="form-group">
<label class="col-md-4 control-label" for="additional-supplies">Please List any additional supplies/equipment you will need for this program (max 1000 char.)</label>
<div class="col-md-4">
<textarea class="form-control" id="additional-supplies" name="additional-supplies"></textarea>
</div>
</div>
<!-- Multiple Checkboxes (inline) -->
<div class="form-group">
<label class="col-md-4 control-label" for="electronic-signature"></label>
<div class="col-md-4">
<label class="checkbox-inline" for="electronic-signature-0">
<input type="checkbox" name="electronic-signature" id="electronic-signature-0" value="signed">
In Checking this, I "Tester" sign here on "Test Date"
</label>
</div>
</div>
<div class="form-group">
<label class="col-md-4 control-label" for="button1id"></label>
<div class="col-md-8">
<button id="button1id" name="button1id" class="btn btn-success">Submit</button>
<button id="reset-form" name="reset-form" class="btn btn-danger">Reset</button>
</div>
</div>
</fieldset>
</form>
<h5> Currently Logged in as: John Bull.</h5>
<script src="https://code.jquery.com/jquery-2.1.4.min.js"></script>
<script src="https://maxcdn.bootstrapcdn.com/bootstrap/3.3.5/js/bootstrap.min.js"></script>
</body>
</html>
.inline{
/*display:inline-block*/
}
.form-group > .center{
text-align:center;
}
.form-group > .left-push{
text-align:left;
padding-left: 18%;
}
.soft-push{
margin-left: 6%
}
