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<h1>Contact Information</h1>
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<td bgcolor="#ffffff" valign="top" width="225">SIUE School of Engineering<br /> Campus Box 1804<br /> Engineering Bldg Room 3057<br /> Edwardsville, IL 62026-1804<br /><br /><br /></td>
<td bgcolor="#ffffff" valign="top" width="225">Phone: 618-650-2541<br /> Fax: 618-650-3374<br /> E-mail: <a href="mailto:engineering@siue.edu">engineering@siue.edu</a><br /><br /></td>
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<h2>We Want to Hear From You......</h2>
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<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>
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<td width="247" valign="top"><input name="interests" type="checkbox" value="Advisement Information" /><strong>Advisement Information<br /></strong><input name="interests" type="checkbox" value="Undergraduate Programs" /><strong>Undergraduate Programs</strong><br /><input name="interests" type="checkbox" value="Graduate Programs" /><strong>Graduate Programs</strong></td>
<td width="121" valign="top"><strong><input name="interests" type="checkbox" value="General Inquiry" />General Inquiry</strong><br /><input name="interests" type="checkbox" value="Other" /><strong>Other</strong></td>
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<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>
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