<HTML>
<TITLE> Mood Questionnaire | HTML Demonstration </TITLE>
<FORM ACTION = 'mailto:fraley@uic.edu' METHOD = 'post' ENCTYPE =
'text/plain'>
<INPUT TYPE = 'hidden' NAME = 'v0' VALUE = 'MoodSurvey'>
<TABLE CELLPADING = '2' >
<TR>
<TD bgcolor = '000066'><IMG SRC = '/images/relationalstructures.jpg'
></TD>
<TD><FONT FACE = 'arial' SIZE = '5'> Mood Questionnaire </TD>
</TR>
<TR>
<TD bgcolor = '000066'></TD>
<TD><FONT FACE = 'arial' SIZE = '2'>Please indicate whether you are
<I>currently</I> experiencing the following mood
states.<BR><BR>
<TABLE>
<TR>
<TD><FONT FACE = 'arial' SIZE = '2'><B>happy </B>
    </TD>
<TD><FONT FACE = 'arial' SIZE = '2'><I>no</I> <INPUT
TYPE = 'radio' NAME = 'v1' value = '0'> </TD>
<TD><INPUT TYPE = 'radio' NAME = 'v1' value = '1'><FONT FACE =
'arial' SIZE = '2'><I>yes</I></TD>
</TR>
<TR>
<TD><FONT FACE = 'arial' SIZE = '2'><B>anxious</B>
    </TD>
<TD><FONT FACE = 'arial' SIZE = '2'><I>no</I> <INPUT
TYPE = 'radio' NAME = 'v2' value = '0'> </TD>
<TD><INPUT TYPE = 'radio' NAME = 'v2' value = '1'><FONT FACE =
'arial' SIZE = '2'><I>yes</I></TD>
</TR>
<TR>
<TD><FONT FACE = 'arial' SIZE = '2'><B>curious</B>
    </TD>
<TD><FONT FACE = 'arial' SIZE = '2'><I>no</I> <INPUT
TYPE = 'radio' NAME = 'v3' value = '0'> </TD>
<TD><FONT FACE = 'arial' SIZE = 2><INPUT TYPE = 'radio' NAME =
'v3' value = '1'><I>yes</I></TD>
</TR>
<TR>
<TD><FONT FACE = 'arial' SIZE = '2'><B>sorrowful
</B>    </TD>
<TD><FONT FACE = 'arial' SIZE = '2'><I>no</I> <INPUT
TYPE = 'radio' NAME = 'v4' value = '0'> </TD>
<TD><INPUT TYPE = radio NAME = 'v4' value='1'><FONT FACE =
'arial' SIZE = '2'><I>yes</I></TD>
</TR>
</TABLE>
<BR><BR><FONT FACE = 'arial' SIZE = '2'><INPUT TYPE =
'submit' VALUE = 'Click here when finished'><BR><BR>
<I>Thank you for your participation!</I>
</FORM>
</TD>
</TR>
</TABLE>
</HTML>