This should be a parent
pop-up form with fields to fill out, and two buttons "submit" and "cancel".
The top of the form says
Enter information below if you are a parent interested in how FENGA can support your child's interest in STEM
The pop-up form collects the following information:
- Name (required, up to 50 characters)
- Email address (required, up to 50 characters)
- school (up to 100 characters, optional)
- city (up to 40 characters, optional)
- state (up to 20 characters, optional)
- message (up to 200 characters, optional)
When the user clicks "Submit" the email address is checked for the
right format (e.g., must contain an asterisk).
If the email address is bad,
an error message is shown and the form does not close.
If the email address is acceptable,
the form information is stored in a database with a timestamp, and
the contents of the form are
sent to the email address: info_parent@fenga.org