User:Jeremi/CI Form Test

{{#CI form: | email-to = jplazas@tsadra.org | paging = 10 |

{{#CI form section: type = inputs responsive | title = Personal Information | First name [] * | Last name [] * | Date of birth [date] * | Country of birth [select=United States of America, Afghanistan, Albania, Algeria, Andorra, Angola, Antigua and Barbuda, Argentina, Armenia, Australia, Austria, Azerbaijan, Bahamas, Bahrain, Bangladesh, Barbados, Belarus, Belgium, Belize, Benin, Bhutan, Bolivia, Bosnia and Herzegovina, Botswana, Brazil, Brunei, Bulgaria, Burkina Faso, Burundi, Cabo Verde, Cambodia, Cameroon, Canada, Central African Republic, Chad, Chile, China, Colombia, Comoros, Congo (Congo-Brazzaville), Costa Rica, Croatia, Cuba, Cyprus, Czechia (Czech Republic), Côte d'Ivoire, Democratic Republic of the Congo, Denmark, Djibouti, Dominica, Dominican Republic, Ecuador, Egypt, El Salvador, Equatorial Guinea, Eritrea, Estonia, Eswatini (fmr. "Swaziland"), Ethiopia, Fiji, Finland, France, Gabon, Gambia, Georgia, Germany, Ghana, Greece, Grenada, Guatemala, Guinea, Guinea-Bissau, Guyana, Haiti, Honduras, Hungary, Iceland, India, Indonesia, Iran, Iraq, Ireland, Israel, Italy, Jamaica, Japan, Jordan, Kazakhstan, Kenya, Kiribati, Kuwait, Kyrgyzstan, Lao People's Democratic Republic, Latvia, Lebanon, Lesotho, Liberia, Libya, Liechtenstein, Lithuania, Luxembourg, Madagascar, Malawi, Malaysia, Maldives, Mali, Malta, Marshall Islands, Mauritania, Mauritius, Mexico, Micronesia, Moldova, Monaco, Mongolia, Montenegro, Morocco, Mozambique, Myanmar, Namibia, Nauru, Nepal, Netherlands, New Zealand, Nicaragua, Niger, Nigeria, North Korea, North Macedonia, Norway, Oman, Pakistan, Palau, Panama, Papua New Guinea, Paraguay, Peru, Philippines, Poland, Portugal, Qatar, Romania, Russia, Rwanda, Saint Kitts and Nevis, Saint Lucia, Saint Vincent and the Grenadines, Samoa, San Marino, Sao Tome and Principe, Saudi Arabia, Senegal, Serbia, Seychelles, Sierra Leone, Singapore, Slovakia, Slovenia, Solomon Islands, Somalia, South Africa, South Korea, South Sudan, Spain, Sri Lanka, State of Palestine, Sudan, Suriname, Sweden, Switzerland, Syria, Tajikistan, Tanzania, Thailand, Timor-Leste, Togo, Tonga, Trinidad and Tobago, Tunisia, Turkey, Turkmenistan, Tuvalu, Uganda, Ukraine, United Arab Emirates, United Kingdom, Uruguay, Uzbekistan, Vanuatu, Vatican City, Venezuela, Vietnam, Yemen, Zambia, Zimbabwe] * }}

{{#CI form section: type = inputs responsive | title = Address | Street [] * | Add. line 2 [] * | City [] * | State / Prov. [] * | Postal code [] * | Country [select=United States of America, Afghanistan, Albania, Algeria, Andorra, Angola, Antigua and Barbuda, Argentina, Armenia, Australia, Austria, Azerbaijan, Bahamas, Bahrain, Bangladesh, Barbados, Belarus, Belgium, Belize, Benin, Bhutan, Bolivia, Bosnia and Herzegovina, Botswana, Brazil, Brunei, Bulgaria, Burkina Faso, Burundi, Cabo Verde, Cambodia, Cameroon, Canada, Central African Republic, Chad, Chile, China, Colombia, Comoros, Congo (Congo-Brazzaville), Costa Rica, Croatia, Cuba, Cyprus, Czechia (Czech Republic), Côte d'Ivoire, Democratic Republic of the Congo, Denmark, Djibouti, Dominica, Dominican Republic, Ecuador, Egypt, El Salvador, Equatorial Guinea, Eritrea, Estonia, Eswatini (fmr. "Swaziland"), Ethiopia, Fiji, Finland, France, Gabon, Gambia, Georgia, Germany, Ghana, Greece, Grenada, Guatemala, Guinea, Guinea-Bissau, Guyana, Haiti, Honduras, Hungary, Iceland, India, Indonesia, Iran, Iraq, Ireland, Israel, Italy, Jamaica, Japan, Jordan, Kazakhstan, Kenya, Kiribati, Kuwait, Kyrgyzstan, Lao People's Democratic Republic, Latvia, Lebanon, Lesotho, Liberia, Libya, Liechtenstein, Lithuania, Luxembourg, Madagascar, Malawi, Malaysia, Maldives, Mali, Malta, Marshall Islands, Mauritania, Mauritius, Mexico, Micronesia, Moldova, Monaco, Mongolia, Montenegro, Morocco, Mozambique, Myanmar, Namibia, Nauru, Nepal, Netherlands, New Zealand, Nicaragua, Niger, Nigeria, North Korea, North Macedonia, Norway, Oman, Pakistan, Palau, Panama, Papua New Guinea, Paraguay, Peru, Philippines, Poland, Portugal, Qatar, Romania, Russia, Rwanda, Saint Kitts and Nevis, Saint Lucia, Saint Vincent and the Grenadines, Samoa, San Marino, Sao Tome and Principe, Saudi Arabia, Senegal, Serbia, Seychelles, Sierra Leone, Singapore, Slovakia, Slovenia, Solomon Islands, Somalia, South Africa, South Korea, South Sudan, Spain, Sri Lanka, State of Palestine, Sudan, Suriname, Sweden, Switzerland, Syria, Tajikistan, Tanzania, Thailand, Timor-Leste, Togo, Tonga, Trinidad and Tobago, Tunisia, Turkey, Turkmenistan, Tuvalu, Uganda, Ukraine, United Arab Emirates, United Kingdom, Uruguay, Uzbekistan, Vanuatu, Vatican City, Venezuela, Vietnam, Yemen, Zambia, Zimbabwe] * }}

{{#CI form section: type = inputs responsive | title = Contact Information | Email [email] * | Phone [tel] * }}

{{#CI form section: type = multiple choice | max answers = 1 | title = Retreat type | Three-year retreat | Solitary hermitage }}

{{#CI form section: type = input | title = 3. What is your favorite pastime? |[Please chose one=select=Reading,Programming,Navigating the web,All of the above,Other,No answer] * | (if you selected "other") [text] }}

{{#CI form section: type = multiple choice | list-type = none | max answers = 1 | title = 4. What is your favorite color ? | Red | Orange | Yellow | Green | Blue | Indigo | Violet | Plaid | Other [] | No answer }}

{{#CI form section: type = multiple choice | title = 5. Who is your favorite relative ? | Father | Mother | Sister | Brother | Uncle | Aunt | Grandfather | Grandmother | No answer }}

{{#CI form section: type = inputs | title = Why ? | [textarea] }}

{{#CI form section: type = inputs | title = 6. How much do you like these foods ? | Broccoli [Chose one=select=Hate,Dislike,Ambivalent,Like,Love,No answer] | Ice Cream [Chose one=select=Hate,Dislike,Ambivalent,Like,Love,No answer] | Chocolate [Chose one=select=Hate,Dislike,Ambivalent,Like,Love,No answer] | Steak [Chose one=select=Hate,Dislike,Ambivalent,Like,Love,No answer] | Escargot [Chose one=select=Hate,Dislike,Ambivalent,Like,Love,No answer] }}

{{#CI form section: type = inputs | title = 7. How much pain to you currently feel in the following locations? 1 = none, 10 = extreme | Head [Chose one=select=1,2,3,5,6,7,8,9,10,No answer] * Torso [Chose one=select=1,2,3,5,6,7,8,9,10,No answer] | Back [Chose one=select=1,2,3,5,6,7,8,9,10,No answer] Seat [Chose one=select=1,2,3,5,6,7,8,9,10,No answer] | Hands [Chose one=select=1,2,3,5,6,7,8,9,10,No answer] Feet [Chose one=select=1,2,3,5,6,7,8,9,10,No answer] }}

{{#CI form section: type = inputs | title = 8. How much do you like the following? (1 = not at all, 5 = extremely) | Ballet [Chose one=select=1,2,3,5,No answer] Jazz [Chose one=select=1,2,3,5,No answer] | Ballroom [Chose one=select=1,2,3,5,No answer] Tap [Chose one=select=1,2,3,5,No answer] | Contemporary [Chose one=select=1,2,3,5,No answer] Hip Hop [Chose one=select=1,2,3,5,No answer] }}

{{#CI form section: type = inputs | title = 9. How should the following change? | Funding for education [Chose one=select=Increase, Same, Decrease,No answer] Funding for security (e.g. police, jails, military) [Chose one=select=Increase, Same, Decrease,No answer] | Availability of high quality health care [Chose one=select=Increase, Same, Decrease,No answer] | Compensation for teachers [Chose one=select=Increase, Same, Decrease,No answer] Compensation for executives [Chose one=select=Increase, Same, Decrease,No answer] | Taxes on the rich [Chose one=select=Increase, Same, Decrease,No answer] Taxes on you [Chose one=select=Increase, Same, Decrease,No answer] }}

{{#CI form section: type = inputs responsive | title = 10. How long should it take to fix the following? | All bugs in LimeSurvey 1.91+ [Chose one=select=1,2,3,4,5,6,7,8,9,10] [Chose one=select=days,weeks,years] | All items on your To Do list [Chose one=select=1,2,3,4,5,6,7,8,9,10] [Chose one=select=days,weeks,years] | All items on your 'honey-do' list [Chose one=select=1,2,3,4,5,6,7,8,9,10] [Chose one=select=days,weeks,years] | The economy [Chose one=select=1,2,3,4,5,6,7,8,9,10] [Chose one=select=days,weeks,years] }}

{{#CI form section: type = cloze test | list-type = none | title = 11. Who are your favorite characters in the following? |

<html>

	Favorite	Second most	Third most
Harry Potter	[]	[]	[]
Star Trek	[]	[]	[]
Star Wars	[]	[]	[]

</html>

}}

{{#CI form section: type = inputs responsive | title = 12. Which of the following conditions have you had? | cancer [Chose one=select=Yes,Uncertain,No,No answer] | heart attack [Chose one=select=Yes,Uncertain,No,No answer] | diabetes [Chose one=select=Yes,Uncertain,No,No answer] | obesity [Chose one=select=Yes,Uncertain,No,No answer] | depression [Chose one=select=Yes,Uncertain,No,No answer] }}

{{#CI form section: type = inputs responsive | title = 13. How tall are the following? | Short [Chose one=select=House,Ferris Wheel (not including the London Eye),U.S. Capitol building,Washington Monument,Empire State Building] | Medium [Chose one=select=House,Ferris Wheel (not including the London Eye),U.S. Capitol building,Washington Monument,Empire State Building] | Tall [Chose one=select=House,Ferris Wheel (not including the London Eye),U.S. Capitol building,Washington Monument,Empire State Building] | No answer [Chose one=select=House,Ferris Wheel (not including the London Eye),U.S. Capitol building,Washington Monument,Empire State Building] }}

{{#CI form section: type = inputs responsive | title = 14. For each of these issues, how severe and bothersome are they? | Financial woes [Chose one=select=Mild Severity,Moderate Severity,Extreme Severity,Mild Bothersomeness,Moderate Bothersomeness,Extreme Bothersomeness,No answer] | Health concerns [Chose one=select=Mild Severity,Moderate Severity,Extreme Severity,Mild Bothersomeness,Moderate Bothersomeness,Extreme Bothersomeness,No answer] | Ability to get your doctors to listen [Chose one=select=Mild Severity,Moderate Severity,Extreme Severity,Mild Bothersomeness,Moderate Bothersomeness,Extreme Bothersomeness,No answer] }}

{{#CI form section: type = inputs | title = 15. When was your most recent birthday? | [date] }}

{{#CI form section: type = inputs | title = 16. Please upload a picture (not supported) }}

{{#CI form section: type = multiple choice | title = 17. What gender are you? | female {{#fas:venus}} | male {{#fas:mars}} | no answer {{#fas:genderless}} }}

{{#CI form section: type = inputs | title = 18. Pick a new language | [Choose your language=select=Template:Languages] }}

{{#CI form section: type = inputs responsive | title = 19. How old are the following people (or how old were they when they died)? | Yourself [number] | Your mother [number] | Your father [number] }}

{{#CI form section: type = inputs responsive | title = 20. How old are you? | [number] }}

{{#CI form section: type = cloze test | css-class= ciform-favorite-activities | title = 21. Please rate your favorite activities: | [] Sleeping | [] Programming | [] Watching television | [] Time with family }}

{{#CI form section: type = inputs | title = 22. This is just a text display. Is the rendered value saved anywhere? Is there a database field for it (e.g. to emulate the Equation question type)? }}

{{#CI form section: type = multiple choice | title = 23. Do you love CIForms ? | yes {{#fas:check}} | no {{#fas:ban}} | no answer {{#far:circle}} }}

{{#CI form section: type = inputs | title = 24. Please paste your resume | [textarea] }}

{{#CI form section: type = inputs | title = 25. (let's skip this) }}

{{#CI form section: type = cloze test | list-type = none | title = 26. What are the names of your best friends? | Favorite Friend [] | Favorite Family Member [] | Favorite Co-Worker [] }}

{{#CI form section: type = inputs | title = 27. What is your favorite food ? | [] }}

{{#CI form section: type = multiple choice | title = 28. Where would you like to vacation this year? | Hawaii | Bahamas | Europe | New Zealand }}

{{#CI form section: type = multiple choice | max answers = 3 | title = 29. Which of the following do you like? Please comment why or why not for each. | Junk Food [] | Reality TV [] | Excercise [] }}

}}