action); $action = $get->action; $post = ""; }else{ $post = new objector($_POST); $get = ""; define("ACTION", $post->action); $action = $post->action; } switch($action){ case"sendit": session_start(); require_once("inc/config.php"); // included files and post-get stuff... require_once($config["htmlRootDir"]."/lib/functions.php"); require_once($config["htmlRootDir"]."/lib/imageTool.php"); require_once($config["htmlRootDir"]."/lib/timeConversion.php"); require_once($config["htmlRootDir"]."/lib/objector.php"); require_once($config["htmlRootDir"]."/lib/aStore.php"); require_once($config["htmlRootDir"]."/lib/aForum.php"); require_once($config["htmlRootDir"]."/lib/printForum.php"); require_once($config["htmlRootDir"]."/lib/aCart.php"); require_once($config["htmlRootDir"]."/lib/aExam.php"); require_once($config["htmlRootDir"]."/lib/users.php"); require_once($config["htmlRootDir"]."/lib/aFaculty.php"); require_once($config["htmlRootDir"]."/lib/storePrintFunctions.php"); /* print""; foreach($_POST AS $key=>$value){ $val = '$row->'; print<< eof; } print"
$key
"; */ /* Here is the meat of the sendmail function. First we change the variable * $from to $email_address to keep it easy to understand */ $errors =0; $msg=""; $resp = recaptcha_check_answer ($privatekey,$_SERVER["REMOTE_ADDR"],$_POST["recaptcha_challenge_field"], $_POST["recaptcha_response_field"]); if ($resp->is_valid) { } else { $errors++; $msg.="The two words you entered in the re-captcha box did not match the words in the image. Please try again.
"; } if($_POST["firstname"]==""){ $errors++; $msg.="You must enter your first name
"; } if($_POST["lastname"]==""){ $errors++; $msg.="You must enter your last name
"; } if($_POST["hphone"]==""){ $errors++; $msg.="You must enter your home phone
"; } if($_POST["address"]==""){ $errors++; $msg.="You must enter your full address
"; } if($_POST["city"]==""){ $errors++; $msg.="You must enter your city
"; } if($_POST["state"]==""){ $errors++; $msg.="You must enter your state
"; } if($_POST["zipcode"]==""){ $errors++; $msg.="You must enter your zipcode
"; } if($_POST["dob"]==""){ $errors++; $msg.="You must enter your date of birth
"; } if($_POST["session"]==""){ $errors++; $msg.="You must choose a session to attend
"; } if($_POST["email_address"]==""){ $errors++; $msg.="You must enter your email address
"; } if($_POST["reach"]==""){ $errors++; $msg.="You must tell us if you've been convicted of an drug related offense
"; } if($_POST["ged"]==""){ $errors++; $msg.="You must tell us if you have a high school deploma or a GED
"; } /* if($_POST["contactrefs"]==""){ $errors++; $msg.="You must agree to allow us to contact your references or not
"; } */ if($_POST["correct"]==""){ $errors++; $msg.="You must tell certify that all the form information is true
"; } if($_POST["marketing"]==""){ $errors++; $msg.="You must tell us where you heard about us
"; } if($_POST["marketing"]=="Other" && $_POST["marketing_other"]==""){ $errors++; $msg.="If you specify 'Other' as where you heard about us, please tell us the other source
"; } if($errors!=0) { include("inc/head.php"); print"

Application

"; print<<Error

The following errors occured while trying to process your request.
$msg

Please review your errors, make your changes and re-submit.

eof; }else{ $firstname = $_POST["firstname"]; $lastname = $_POST["lastname"]; $hphone = $_POST["hphone"]; $mphone = $_POST["mphone"]; $address = $_POST["address"]; $city = $_POST["city"]; $state = $_POST["state"]; $zipcode = $_POST["zipcode"]; $dob = $_POST["dob"]; $reach = $_POST["reach"]; $emergency = $_POST["emergency"]; $emergencycontact = $_POST["emergencycontact"]; $level = $_POST["level"]; $clevel = $_POST["clevel"]; $degree = $_POST["degree"]; $ged = $_POST["ged"]; $completedate = $_POST["completedate"]; $grammer = $_POST["grammer"]; $highschool = $_POST["highschool"]; $college = $_POST["college"]; $other = $_POST["other"]; $specialstudy = $_POST["specialstudy"]; $specialskills = $_POST["specialskills"]; $whyattend = $_POST["whyattend"]; $experience = $_POST["experience"]; $ref1 = $_POST["ref1"]; $ref2 = $_POST["ref2"]; $ref3 = $_POST["ref3"]; $contactrefs = $_POST["contactrefs"]; $session = $_POST["session"]; $catalog = $_POST["catalog"]; $correct = $_POST["correct"]; $marketing = $_POST["marketing"]; $marketing_other = $_POST["marketing_other"]; $emailAddress = $_POST["email_address"]; $body = $_POST["body"]; $from = $_POST["email_address"]; $to = "applications@schoolofdentalassisting.com";// . ", " ; //note the comma if($_POST["optIn"]=="y"){ if($db->getOne("SELECT COUNT(list_id) FROM mailingList WHERE emailAddress='{$_POST[email_address]}'")==0){ $db->query("INSERT INTO mailingList(list_id,firstname,lastname,address1,address2,city,state,zip,phone,emailAddress,created,modified) VALUES(null,'{$_POST[firstname]}','{$_POST[lastname]}','{$_POST[address]}','','{$_POST[city]}','{$_POST[state]}','{$_POST[zipcode]}','{$_POST[phone]}','{$_POST[email_address]}',NOW(),NOW())"); } } $new_body = "You have received an application from the DentalAssist.org Online Student Application page. \n\nIt is from $firstname $lastname ($from). \nThe applicant's information is as follows: \n\nEmail: $emailAddress\n\nAddress: $address \nCity: $city \nState: $state \nZip: $zipcode \nHome Phone: $hphone \nMoble Phone: $mphone \nDate of Birth: $dob \nEver been convicted of a drug related offense: $reach \nEmergency Contact Name: $emergency \nRelation and Number: $emergencycontact \n\nEDUCATIONAL DATA: \nHighest Grade Completed: $level \nCollege Year Completed: $clevel \nGraduate Degree: $degree \nHigh School Diploma or G.E.D.: $ged \nCompletion Date: $completedate \n\nEXPERIENCE: \nWhy student wishes to attend dental assisting school: $whyattend \nDescription of any dental office experience you have had up to now: $experience \nSession applying for: $session \nNeed a Catalog: $catalog \nI certify that all the information provided is complete and accurate to the best of my knowledge: $correct \nHow did you hear about us: $marketing $marketing_other \n\nAdditional comments: \n$body"; $mbody = $new_body; $msubject = "CSDA Online Application Form"; $mto = $to; $mtoname = $to; $mfrom = $config['emailFrom']; $mfromname = 'CSDA'; sendEmail($mto,$mtoname, $msubject,$mbody,$mfrom,$mfromname); //mail($config[emailFrom], "NSDA Online Application Form", $new_body ,"From: $from") or die("no mail today"); // here is the function that sends confirmation email...just wipe this line to remove $msubject = "Thank you for your application"; $mbody = "Thanks for applying via the {$config[siteName]} online application form $firstname $lastname. Your application has been received.\n\nA member of our staff will get back to you shortly. \n\nSincerely,\n\nThe Staff at the {$config[siteName]}.\n\n\nPlease do not reply to this email address, it is used for sending mail only."; $mfrom = $config[emailFrom]; $mfromname = 'CSDA'; $mto = $from; $mtoname = $from; //sendEmail($mto,$mtoname, $msubject,$mbody,$mfrom,$mfromname); //mail($from, "Thank you for your application", "Thanks for applying via the {$config[siteName]} online application form $firstname $lastname. Your application has been received.\n\nA member of our staff will get back to you shortly. \n\nSincerely,\n\nThe Staff at the {$config[siteName]}.\n\n\nPlease do not reply to this email address, it is used for sending mail only.", "From: {$config[emailFrom]}\r\n"); //sendEmail($to,$toname, $subject,$contents,$from,$fromname) //mail($to, "CSDA Online Application Form", $new_body ,"From: $to") or die("no mail today"); if(sendEmail($mto,$mtoname, $msubject,$mbody,$mfrom,$mfromname)){ header("Location: /application_success.php"); exit; }else{ print<<Error

There was an error processing your request. Please email us for assistance

eof; include("inc/foot.php"); exit; } } break; default: include('inc/head.php'); break; } print<<

Register 30 days before the start of each session and receive $200 off tuition!
APPLICATIONS ARE ACCEPTED THROUGHOUT THE YEAR FOR ALL SESSIONS
An application is required for the Dental Assisting Program and the EDDA Course.
Denotes required fields
First Name Last Name
Street Address
City State Zip
Home Phone Mobile Phone

Email Date of Birth

Ever been convicted of a drug related offense? Yes No
In case of emergency, whom should we contact?
Relation and Phone Number
Would you like to receive our newsletter? Yes, please
No, thanks


EDUCATIONAL DATA

Highest Grade Completed College
Graduate Degree Yes No
High School Diploma or G.E.D.? Yes No Completion Date


EXPERIENCE

Please state briefly why you wish to attend dental assisting school:
Please describe any dental office experience you have had up to now:
(EDDA applicants must have at least 1 year of full time dental assisting experience)


Session applying for
Need a Catalog Yes No
I certify that all the information provided is complete and accurate to the best of my knowledge.
Yes No
How did you hear about us? If Other:
Additional Comments:
Please enter the text you see from the image below:



eof; include("inc/foot.php"); ?>