document.write("<table border=0 cellspacing=0 cellpadding=5 cols=2 bordercolorlight='#000000' width='340' bordercolor='#000000' align='center' >")
document.write("<form name='CompetencyForm' action='http://www.studentdoc.com/residency.php' method='post'>")
document.write("<tr> <td colspan=3><b>Enter scores & press 'Search Specialties'</b></td> </tr>")
document.write("<tr> <td width='145'><font face='Arial Narrow'><font color='red' size=-1>*</font> USMLE Step 1 Score:</font></td>")

document.write("<td width='52'> <input type='text' name='usmlescore' value='0' maxlength='3' size='4'> </td>")
document.write("<td rowspan='3' width='113'> <div align='center'> Visit our<br /><a href='http://www.studentdoc.com/phpBB2/' target='_forum'><b>Medical Student Forum</b></a><br />")
document.write("<font size='2'>(opens in new window)</font></div>")
document.write("</td></tr>")

document.write("<tr> <td width='145'><font face='Arial Narrow'> <font color='red' size=-1>*</font> Do you anticipate being AOA:</font> </td>")
document.write("<td width='52'> <input type='radio' name='AOA' value='Yes'> <font size='2' face='Arial, Helvetica, sans-serif'> Yes <br/> <input type='radio' name='AOA' value='No' checked>No</font></td>")
document.write("</tr>              <tr> ")
document.write("<td width='145'><font face='Arial Narrow'> <font color='red' size=-1>*</font> Have you done research?</font></td>")
document.write("  <td width='52'> <input type='radio' name='research' value='Yes'> <font size='2' face='Arial, Helvetica, sans-serif'> Yes <br />")
document.write("    <input type='radio' name='research' value='No' checked> No</font> </td>")
document.write("</tr>                <tr> ")

document.write("<td width='145'><font face='Arial Narrow'> <font color='red' size=-1>*</font> Do you have research publications?</font> </td>")

document.write("<td width='52'> <input type='radio' name='publication' value='Yes'> <font size='2' face='Arial, Helvetica, sans-serif'> Yes <br />")
document.write("<input type='radio' name='publication' value='No' checked> No</font> </td> <td width='113'>&nbsp;</td>")
document.write("</tr>                <tr> ")

document.write("<td width='145'><font face='Arial Narrow'> <font color='red' size=-1>*</font> Will you be applying as a senior in a US medical school?</font> </td>")

document.write("<td width='52'> <input type='radio' name='ussen' value='Yes' checked> <font size='2' face='Arial, Helvetica, sans-serif'> Yes <br>")
document.write("<input type='radio' name='ussen' value='No'> No</font> </td>                  <td width='113'>&nbsp;</td>")
document.write("</tr>                <tr> ")

document.write("<td width='145'> <input type='reset' name='reset' value='Reset'> </td>")
document.write("<td colspan='2' align='left'> <input type='hidden' name='resnum' value='0'> <input type='submit' name='submit' value='search Specialties'> </td>")
document.write("                </tr>	              </form>	            </table>")