<h2>Contact Information</h2><form name="mail" action="http://www.siue.edu/cgi-bin/FormMail.pl" method="post"><input name="recipient" type="hidden" value="jwottow@siue.edu" /><input name="subject" type="hidden" value="OCECA Web Inquiry" /><input name="required" type="hidden" value="email,realname" /><input name="redirect" type="hidden" value="http://www.siue.edu/education/advisement/thanks.shtml" /> <table bgcolor="#cccccc" border="0" width="675" cellpadding="0" cellspacing="0" align="left"> <tr> <td bgcolor="#ffffff" valign="top" width="225">Office of Clinical Experiences, Certification, and Advisement<br />Founders Hall, Suite 1110<br />Campus Box 1062<br />Edwardsville, IL 62026<br /><br /><br /></td> <td bgcolor="#ffffff" valign="top" width="225">Phone: 618.650.3940<br />FAX: 618.650.5468<br />E-mail: <a href="mailto:ocecahelpdesk@siue.edu" target="_blank">ocecahelpdesk@siue.edu</a><br /><br /></td> <td bgcolor="#ffffff" valign="top" width="225"></td> </tr> <tr> <td bgcolor="#ffffff" valign="top" width="225" colspan="2"> <h2>We Want to Hear From You......</h2> </td> <td bgcolor="#ffffff" valign="top" width="225"></td> </tr> <tr> <td valign="top" width="450" colspan="2"> <table bgcolor="#cccccc" border="0" width="450" cellpadding="10" cellspacing="0" align="left"> <tr> <td valign="top" colspan="2"><strong><span style="color:#FF0000">*</span></strong><strong>Name</strong> <input name="realname" size="40" type="text" value="Enter your full name" onfocus="this.value=''" id="realname" /> <br /><br /><strong><span style="color:#FF0000">*</span>E-mail <input name="email" size="40" type="text" value="Enter your e-mail address" onfocus="this.value=''" id="email" /><br /><br />I have a question regarding:</strong><br /><span style="color:#FF0000">*</span>(check all that apply)</td> </tr> <tr> <td valign="top"><input name="interests" type="checkbox" value="Advisement Information" /><strong>Advisement Information<br /></strong><input name="interests" type="checkbox" value="Teacher Certification" /><strong>Teacher Certification</strong><br /><input name="interests" type="checkbox" value="Graduate Information" /><strong>Graduate Information</strong></td> <td valign="top"><input name="interests" type="checkbox" value="Off Campus Programs" /><strong>Off Campus Programs<br /><input name="interests" type="checkbox" value="Field Placements" />Field Placements</strong><br /><input name="interests" type="checkbox" value="General Inquiry" /><strong>General Inquiry</strong></td> </tr> <tr> <td valign="top" colspan="2"><strong>Comments.</strong><br /><br /> <textarea name="comments" rows="5" cols="45" onfocus="this.value=''" id="comments"> Comments... </textarea><br /><br /> <input type="submit" value="Submit" /></td> </tr> </table> </td> <td height="400" bgcolor="#ffffff" valign="top" width="225"><img height="400" border="0" width="225" alt="Contact Us Picture" src="/id0904f67a805bf515" /></td> </tr> </table></form>