"
FormatVariableLine = tmpStr
end function
Sub OutputLine(byVal line)
outfile.WriteLine(line)
end sub
if err.number = 0 then
Set outfile = fso.CreateTextFile(filename, true, false)
if err.number <> 0 then
bErr = true
errStr = "Error creating file! Directory may not be writable or may not exist.
Unable to process request."
else
if(req_method = "GET") then
for each Item in request.QueryString
if item <> "" then
bEmpty = false
key = item
value = Request.QueryString(item)
if(lcase(key) = "redirect") then
landing_page = value
else
line = FormatVariableLine(key, value)
Call OutputLine(line)
end if
end if
next
elseif (req_method = "POST") then
for each Item in request.form
if item <> "" then
bEmpty = false
key = item
value = Request.form(item)
if(lcase(key) = "redirect") then
landing_page = value
else
line = FormatVariableLine(key, value)
Call OutputLine(line)
end if
end if
next
end if
outfile.close
end if
if(bEmpty = true) AND errStr = "" then
bErr = true
errStr = errStr & "
No variables sent to form! Unable to process request."
end if
if(bErr = false) then
if (landing_page <> "") then
response.Redirect "http://" & host_url & "/" & landing_page
else
response.Redirect "http://" & host_url
end if
else
Response.Write errStr
end if
set fso = nothing
else
Response.Write " An Error Occurred creating mail message. Unable to process form request at this time."
end if
%>
Scholarship Application
(Print)
Registration Form
(Please Print)
Name:
Title:
Agency/Practice:
Address:
City:
State:
Zip:
Email:______________________________ Phone(s):_____________________________
You may print and
mail, or email your application.
New Mexico Addiction Education Network
c/o Western New Mexico University
Dr. John Bourdette
Phelps Dodge 134
Silver City,
NM 88062
For questions and
information about the Institute or Silver City, visit our website
www.nmaen.org or email
nmaenorg@gmail.com
Date of Application:
__________________________
Demonstrate
Financial Need: (Explain why you need this financial assistance)
Demonstrate Need
for Training: (Why do you need the training?)
Document Service
to the field -
Why are you more
deserving of this award than the other applicants? (If
you have not been able to contribute service, it will not prevent you from
getting a scholarship, but those who have done so will be given preference. You
may also contribute by serving during the Institute.)
Document
Professional Goals. (What will you use the training to accomplish?)