{"id":9819,"date":"2026-03-16T05:09:18","date_gmt":"2026-03-16T05:09:18","guid":{"rendered":"https:\/\/old-website.retprogram.org\/wahtn\/?page_id=9819"},"modified":"2026-06-15T05:24:32","modified_gmt":"2026-06-15T05:24:32","slug":"suite-crm-test-tom","status":"publish","type":"page","link":"https:\/\/old-website.retprogram.org\/wahtn\/suite-crm-test-tom\/","title":{"rendered":"Suite CRM Test Tom"},"content":{"rendered":"<div class=\"wp-block-bplugins-custom-html\" id='bPluginsCustomHtml-1'>\n<style type=\"text\/css\">\nform#WebToLeadForm, form#WebToLeadForm * {margin: 0; padding: 0; border: none; color: #333; font-size: 12px; line-height: 1.6em; font-family: 'Helvetica Neue', Helvetica, Arial, sans-serif;}\nform#WebToLeadForm {float: left; border: 1px solid #ccc; margin: 10px;}\nform#WebToLeadForm h1 {font-size: 32px; font-weight: bold; background-color: rgb(60, 141, 188); color: rgb(247, 247, 247); padding: 10px 20px;}\nform#WebToLeadForm h2 {font-size: 24px; font-weight: bold; background-color: rgb(60, 141, 188); color: rgb(247, 247, 247); padding: 10px 20px;}\nform#WebToLeadForm h3 {font-size: 12px; font-weight: bold; padding: 10px 20px;}\nform#WebToLeadForm h4 {font-size: 10px; font-weight: bold; padding: 10px 20px;}\nform#WebToLeadForm h5 {font-size: 8px; font-weight: bold; padding: 10px 20px;}\nform#WebToLeadForm h6 {font-size: 6px; font-weight: bold; padding: 10px 20px;}\nform#WebToLeadForm p {padding: 10px 20px;}\nform#WebToLeadForm input,\nform#WebToLeadForm select,\nform#WebToLeadForm textarea {border: 1px solid #ccc; display: block; float: left; min-width: 170px; padding: 5px;}\nform#WebToLeadForm select {background-color: white;}\nform#WebToLeadForm input[type=\"button\"],\nform#WebToLeadForm input[type=\"submit\"] {display: inline; float: none; padding: 5px 10px; width: auto; min-width: auto;}\nform#WebToLeadForm input[type=\"checkbox\"],\nform#WebToLeadForm input[type=\"radio\"] {width: 18px; min-width: auto;}\nform#WebToLeadForm div.col {display: block; float: left; width: 330px; padding: 10px 20px;}\nform#WebToLeadForm div.clear {display: block; float: none; clear: both; height: 0px; overflow: hidden;}\nform#WebToLeadForm div.center {text-align: center;}\nform#WebToLeadForm div.buttons {padding: 10px 0; border-top: 1px solid #ccc; background-color: #f7f7f7}\nform#WebToLeadForm label {display: block; float: left; width: 160px; font-weight: bold;}\nform#WebToLeadForm span.required {color: #FF0000;}\n\n\/* Anti-spam honeypot styling, keeps the field invisible to human visitors *\/\n.lead-capture-zip-mask { display: none !important; }\n<\/style>\n\n<!-- FORM ENTRYPOINT URL -->\n<!-- CHANGE THIS: Ensure the URL points to your specific SuiteCRM instance if it differs across forms -->\n<form action='https:\/\/suitecrm.cciprogram.org\/index.php?entryPoint=WebToPersonCapture' name='WebToLeadForm' method='POST' id='WebToLeadForm'>\n    <h2>Web form to create Applications<\/h2>\n    <p>Submitting this form will create Applications<\/p>\n    \n    <div class=\"row\">\n        <div class=\"col\">\n            <label>Salutation: <\/label>\n            <select id=\"salutation\" name=\"salutation\" tabindex=\"1\">\n                <option selected value=''>&#8211;None&#8211;<\/option>\n                <option value='Mr.'>Mr.<\/option>\n                <option value='Ms.'>Ms.<\/option>\n                <option value='Mrs.'>Mrs.<\/option>\n                <option value='Miss'>Miss<\/option>\n                <option value='Dr.'>Dr.<\/option>\n                <option value='Prof.'>Prof.<\/option>\n                <option value='Assoc_Prof'>A\/Prof<\/option>\n                <option value='Hon'>Hon<\/option>\n                <option value='mx'>Mx.<\/option>\n            <\/select>\n        <\/div>\n        <div class=\"col\">&nbsp;<\/div>\n        <div class=\"clear\">&nbsp;<\/div>\n    <\/div>\n    \n    <div class=\"row\">\n        <div class=\"col\"><label>First Name: <span class='required'>*<\/span><\/label><input id=\"first_name\" name=\"first_name\" type=\"text\" required><\/div>\n        <div class=\"col\">&nbsp;<\/div>\n        <div class=\"clear\">&nbsp;<\/div>\n    <\/div>\n    \n    <div class=\"row\">\n        <div class=\"col\"><label>Last Name: <span class='required'>*<\/span><\/label><input id=\"last_name\" name=\"last_name\" type=\"text\" required><\/div>\n        <div class=\"col\">&nbsp;<\/div>\n        <div class=\"clear\">&nbsp;<\/div>\n    <\/div>\n    \n    <div class=\"row\">\n        <div class=\"col\"><label>Home Phone: <\/label><input id=\"phone_home\" name=\"phone_home\" type=\"text\"><\/div>\n        <div class=\"col\">&nbsp;<\/div>\n        <div class=\"clear\">&nbsp;<\/div>\n    <\/div>\n    \n    <div class=\"row\">\n        <div class=\"col\"><label>Mobile Phone Number: <span class='required'>*<\/span><\/label><input id=\"phone_mobile\" name=\"phone_mobile\" type=\"text\" required><\/div>\n        <div class=\"col\">&nbsp;<\/div>\n        <div class=\"clear\">&nbsp;<\/div>\n    <\/div>\n    \n    <div class=\"row\">\n        <div class=\"col\"><label>Email Address: <span class='required'>*<\/span><\/label><input id=\"email1\" name=\"email1\" type=\"email\" required><\/div>\n        <div class=\"col\">&nbsp;<\/div>\n        <div class=\"clear\">&nbsp;<\/div>\n    <\/div>\n    \n    <div class=\"row\">\n        <div class=\"col\"><label>Postcode: <span class='required'>*<\/span><\/label><input id=\"primary_address_postalcode\" name=\"primary_address_postalcode\" type=\"text\" required><\/div>\n        <div class=\"col\">&nbsp;<\/div>\n        <div class=\"clear\">&nbsp;<\/div>\n    <\/div>\n    \n    <div class=\"row\">\n        <div class=\"col\">\n            <label>My gender is: <\/label>\n            <select id=\"gender_c\" multiple=\"true\" name=\"gender_c[]\" tabindex=\"1\">\n                <option value='female'>Female<\/option>\n                <option value='male'>Male<\/option>\n                <option value='non_binary'>Non-binary<\/option>\n            <\/select>\n        <\/div>\n        <div class=\"col\">&nbsp;<\/div>\n        <div class=\"clear\">&nbsp;<\/div>\n    <\/div>\n    \n    <div class=\"row\">\n        <div class=\"col\"><label>Year of birth: <span class='required'>*<\/span><\/label><input id=\"birth_year_c\" name=\"birth_year_c\" type=\"text\" required><\/div>\n        <div class=\"col\">&nbsp;<\/div>\n        <div class=\"clear\">&nbsp;<\/div>\n    <\/div>\n    \n    <div class=\"row\">\n        <div class=\"col\">\n            <label>I identify as Aboriginal and \/ or Torres Strait Islander: <\/label>\n            <select id=\"aboriginal_tsi_c\" multiple=\"true\" name=\"aboriginal_tsi_c[]\" tabindex=\"1\">\n                <option value='aboriginal'>Aboriginal<\/option>\n                <option value='torres_strait_islander'>Torres Strait Islander<\/option>\n                <option value='both'>Both<\/option>\n                <option value='no'>No<\/option>\n            <\/select>\n        <\/div>\n        <div class=\"col\">&nbsp;<\/div>\n        <div class=\"clear\">&nbsp;<\/div>\n    <\/div>\n    \n    <div class=\"row\">\n        <div class=\"col\">\n            <label>Ethnicity (Please select): <\/label>\n            <select id=\"ethnicity_select_c\" name=\"ethnicity_select_c\" tabindex=\"1\">\n                <option value='AUS'>Australian<\/option>\n                <option value='NZ'>New Zealander<\/option>\n                <option value='AS'>Asian<\/option>\n                <option value='IN'>Indian<\/option>\n                <option value='ME'>Middle Eastern<\/option>\n                <option value='EU'>European<\/option>\n                <option value='NA'>North American<\/option>\n                <option value='SA'>South American<\/option>\n                <option value='AF'>African<\/option>\n                <option value='DTA'>Decline to answer<\/option>\n                <option value='OT'>Other, please specify<\/option>\n            <\/select>\n        <\/div>\n        <div class=\"col\">&nbsp;<\/div>\n        <div class=\"clear\">&nbsp;<\/div>\n    <\/div>\n    \n    <div class=\"row\">\n        <div class=\"col\"><label>If other, please specify: <\/label><input id=\"if_other4_c\" name=\"if_other4_c\" type=\"text\"><\/div>\n        <div class=\"col\">&nbsp;<\/div>\n        <div class=\"clear\">&nbsp;<\/div>\n    <\/div>\n    \n    <div class=\"row\">\n        <div class=\"col\">\n            <label>I am a: (you can select more than one): <span class='required'>*<\/span><\/label>\n            <select id=\"role_c\" multiple=\"true\" name=\"role_c[]\" tabindex=\"1\" required>\n                <option value='consumer'>Consumer<\/option>\n                <option value='carer'>Carer<\/option>\n                <option value='researcher'>Researcher<\/option>\n            <\/select>\n        <\/div>\n        <div class=\"col\">&nbsp;<\/div>\n        <div class=\"clear\">&nbsp;<\/div>\n    <\/div>\n    \n    <div class=\"row\">\n        <div class=\"col\"><label>Describe your lived experience, What experience do you have to inform the project? (*required for us to consider your application or EOI): <\/label><span class='ta_replace'><input id=\"led_d_c\" name=\"led_d_c\" type=\"text\"><\/span><\/div>\n        <div class=\"col\">&nbsp;<\/div>\n        <div class=\"clear\">&nbsp;<\/div>\n    <\/div>\n    \n    <div class=\"row\">\n        <div class=\"col\"><label>Statement of Interest, Why do you want to be involved with this project: <\/label><span class='ta_replace'><input id=\"description\" name=\"description\" type=\"text\"><\/span><\/div>\n        <div class=\"col\">&nbsp;<\/div>\n        <div class=\"clear\">&nbsp;<\/div>\n    <\/div>\n    \n    <div class=\"row\">\n        <div class=\"col\"><label>Referees provided previously: <\/label><input type=\"checkbox\" id=\"referees_provided_c\" name=\"referees_provided_c\"><\/div>\n        <div class=\"col\">&nbsp;<\/div>\n        <div class=\"clear\">&nbsp;<\/div>\n    <\/div>\n    \n    <div class=\"row\">\n        <div class=\"col\">\n            <label>Referee 1 Type: <\/label>\n            <select id=\"ref1_type_c\" multiple=\"true\" name=\"ref1_type_c[]\" tabindex=\"1\">\n                <option value='employer'>Employer<\/option>\n                <option value='friend'>Friend<\/option>\n                <option value='family'>Family<\/option>\n                <option value='colleague'>Colleague<\/option>\n                <option value='other'>Other<\/option>\n            <\/select>\n        <\/div>\n        <div class=\"col\">&nbsp;<\/div>\n        <div class=\"clear\">&nbsp;<\/div>\n    <\/div>\n    \n    <div class=\"row\">\n        <div class=\"col\"><label>Referee 1 First Name: <\/label><input id=\"ref1_fname_c\" name=\"ref1_fname_c\" type=\"text\"><\/div>\n        <div class=\"col\">&nbsp;<\/div>\n        <div class=\"clear\">&nbsp;<\/div>\n    <\/div>\n    \n    <div class=\"row\">\n        <div class=\"col\"><label>Referee 1 Last Name: <\/label><input id=\"ref1_lname_c\" name=\"ref1_lname_c\" type=\"text\"><\/div>\n        <div class=\"col\">&nbsp;<\/div>\n        <div class=\"clear\">&nbsp;<\/div>\n    <\/div>\n    \n    <div class=\"row\">\n        <div class=\"col\"><label>Referee 1 Phone: <\/label><input id=\"ref1_phone_c\" name=\"ref1_phone_c\" type=\"text\"><\/div>\n        <div class=\"col\">&nbsp;<\/div>\n        <div class=\"clear\">&nbsp;<\/div>\n    <\/div>\n    \n    <div class=\"row\">\n        <div class=\"col\"><label>Referee 1 Email: <\/label><input id=\"ref1_email_c\" name=\"ref1_email_c\" type=\"text\"><\/div>\n        <div class=\"col\">&nbsp;<\/div>\n        <div class=\"clear\">&nbsp;<\/div>\n    <\/div>\n    \n    <div class=\"row\">\n        <div class=\"col\">\n            <label>Referee 2 Type: <\/label>\n            <select id=\"ref2_type_c\" multiple=\"true\" name=\"ref2_type_c[]\" tabindex=\"1\">\n                <option value='employer'>Employer<\/option>\n                <option value='friend'>Friend<\/option>\n                <option value='family'>Family<\/option>\n                <option value='colleague'>Colleague<\/option>\n                <option value='other'>Other<\/option>\n            <\/select>\n        <\/div>\n        <div class=\"col\">&nbsp;<\/div>\n        <div class=\"clear\">&nbsp;<\/div>\n    <\/div>\n    \n    <div class=\"row\">\n        <div class=\"col\"><label>Referee 2 First Name: <\/label><input id=\"ref2_fname_c\" name=\"ref2_fname_c\" type=\"text\"><\/div>\n        <div class=\"col\">&nbsp;<\/div>\n        <div class=\"clear\">&nbsp;<\/div>\n    <\/div>\n    \n    <div class=\"row\">\n        <div class=\"col\"><label>Referee 2 Last Name: <\/label><input id=\"ref2_lname_c\" name=\"ref2_lname_c\" type=\"text\"><\/div>\n        <div class=\"col\">&nbsp;<\/div>\n        <div class=\"clear\">&nbsp;<\/div>\n    <\/div>\n    \n    <div class=\"row\">\n        <div class=\"col\"><label>Referee 2 Phone: <\/label><input id=\"ref2_phone_c\" name=\"ref2_phone_c\" type=\"text\"><\/div>\n        <div class=\"col\">&nbsp;<\/div>\n        <div class=\"clear\">&nbsp;<\/div>\n    <\/div>\n    \n    <div class=\"row\">\n        <div class=\"col\"><label>Referee 2 Email: <\/label><input id=\"ref2_email_c\" name=\"ref2_email_c\" type=\"text\"><\/div>\n        <div class=\"col\">&nbsp;<\/div>\n        <div class=\"clear\">&nbsp;<\/div>\n    <\/div>\n    \n    <div class=\"row\">\n        <div class=\"col\">\n            <label>Access or other requirements: <\/label>\n            <select id=\"access_requirements_c\" multiple=\"true\" name=\"access_requirements_c[]\" tabindex=\"1\">\n                <option value='acrod_parking'>ACROD Parking<\/option>\n                <option value='assistance_dog'>Assistance Dog<\/option>\n                <option value='audio'>Audio<\/option>\n                <option value='documents_printed'>Documents printed out<\/option>\n                <option value='hearing_loop'>Hearing  Loop<\/option>\n                <option value='wheelchair_access'>Wheelchair Access<\/option>\n                <option value='interpreter_other'>Interpreter \/ other cultural support<\/option>\n                <option value='support_carer'>Carer\/support attending<\/option>\n                <option value='other'>Other<\/option>\n            <\/select>\n        <\/div>\n        <div class=\"col\">&nbsp;<\/div>\n        <div class=\"clear\">&nbsp;<\/div>\n    <\/div>\n    \n    <div class=\"row\">\n        <div class=\"col\"><label>If other, please specify: <\/label><input id=\"if_other_c\" name=\"if_other_c\" type=\"text\"><\/div>\n        <div class=\"col\">&nbsp;<\/div>\n        <div class=\"clear\">&nbsp;<\/div>\n    <\/div>\n    \n    <div class=\"row\">\n        <div class=\"col\"><label>Subscribe to Newsletter: <\/label><input type=\"checkbox\" id=\"subscribe_c\" name=\"subscribe_c\"><\/div>\n        <div class=\"col\">&nbsp;<\/div>\n        <div class=\"clear\">&nbsp;<\/div>\n    <\/div>\n\n    <div class=\"row center buttons\">\n        <!-- Intercepts submission sequence directly from click -->\n        <input type=\"submit\" onclick=\"return submit_form();\" class=\"button\" name=\"Submit\" value=\"Submit\" \/>\n        <div class=\"clear\">&nbsp;<\/div>\n    <\/div>\n\n    <!-- Honeypot Field Block -->\n    <div class=\"lead-capture-zip-mask\">\n        <label>Middle Name Verification:<\/label>\n        <input type=\"text\" id=\"middle_name_verification\" name=\"middle_name_verification\" autocomplete=\"off\" tabindex=\"-1\">\n    <\/div>\n\n    <!-- ========================================================================= -->\n    <!--                       CHANGEABLE CRM CONFIGURATIONS                       -->\n    <!-- ========================================================================= -->\n\n    <!-- CHANGE THIS: The ID tracking the specific campaign in SuiteCRM -->\n    <input type='hidden' id='campaign_id' name='campaign_id' value='1e014a0b-9268-5a6e-7817-69e18dd99c66'>\n\n    <!-- CHANGE THIS: The page your user lands on after a successful form submission -->\n    <input type='hidden' id='redirect_url' name='redirect_url' value='http:\/\/cciprogram.org\/thank-you-for-your-submission\/'>\n\n    <!-- CHANGE THIS: The user ID inside your CRM assigned to manage new records -->\n    <input type='hidden' id='assigned_user_id' name='assigned_user_id' value='16c9a3a9-7dac-d2c9-0ae2-5fbc674a2c8c'>\n\n    <!-- CHANGE THIS: List checkbox element IDs separated by semicolons if they change per form template -->\n    <input type='hidden' id='bool_id' name='bool_id' value='referees_provided_c;subscribe_c;'>\n\n    <!-- KEEP STANDARD: Identifies the target destination inside SuiteCRM -->\n    <input type='hidden' id='moduleDir' name='moduleDir' value='Leads'>\n\n<\/form>\n\n<script type='text\/javascript'>\n    \/\/ Capture page initialization timestamp immediately\n    var formLoadTime = Date.now();\n\n    function submit_form() {\n        \/\/ 1. 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