<form-template> <fields> <field type="paragraph" subtype="p" label="Please complete the following information so that the City can investigate your concern. " class="paragraph"></field> <field type="date" required="true" label="Date of Incident" class="form-control calendar" name="date-1491421121498"></field> <field type="text" subtype="text" required="true" label="Name" class="form-control text-input" name="text-1491421130310"></field> <field type="text" subtype="text" required="true" label="Street Address" class="form-control text-input" name="text-1491421148491"></field> <field type="text" subtype="text" required="true" label="Mailing Address" class="form-control text-input" name="text-1491421168067"></field> <field type="text" subtype="text" required="true" label="Phone Number" class="form-control text-input" name="text-1491421198048"></field> <field type="text" subtype="text" required="true" label="Email Address" class="form-control text-input" name="text-1491421219830"></field> <field type="textarea" required="true" label="Nature of concern:" description="Include the date, time, place, and facts of your concern" class="form-control text-area" name="textarea-1491421404233"></field> <field type="textarea" required="true" label="Explain how you feel the concern should be resolved" class="form-control text-area" name="textarea-1491421439916"></field> <field type="date" required="true" label="Date Submitted " class="form-control calendar" name="date-1491421523665"></field> <field type="paragraph" subtype="p" label="City Hall Office Use Only " class="paragraph"></field> <field type="paragraph" subtype="p" label="Received by: ____________________________________ Date: _________________ " class="paragraph"></field> <field type="paragraph" subtype="p" label="Copied to: ______________________________________ Date: _________________" class="paragraph"></field> <field type="paragraph" subtype="p" label="Follow-Up Completed by: __________________________ Date: _________________" class="paragraph"></field> <field type="paragraph" subtype="p" label="Comments: " class="paragraph"></field> </fields> </form-template> Submit Submitting...
