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Submitted URL: https://citizensacademyleader.us/
Effective URL: https://citizensacademy.us/become-a-leader
Submission: On March 30 via automatic, source certstream-suspicious — Scanned from US

Form analysis 1 forms found in the DOM

Name: signup — POST ./send-leader-form

<form style="clear: both;" name="signup" method="post" action="./send-leader-form" onsubmit="document.getElementById('submit').value='Submitting, please wait...';">
  <input type="hidden" name="leader_token" value="4acfbfb030bba1ec9012f733aa37024f">
  <input type="hidden" name="ip" value="38.132.118.67">
  <div class="row">
    <div class="col-md-6">
      <label for="referral" class="form-label">How did you find out about us?</label>
      <select name="referral" id="referral" class="form-select" required="required">
        <option value="" disabled="disabled" selected="selected">Choose...</option>
        <option value="By a friend.">By a friend.</option>
        <option value="I heard about it at a meeting.">I heard about it at a meeting.</option>
        <option value="I received a Citizens Academy service.">I received a Citizens Academy service.</option>
        <option value="other">Other...</option>
      </select>
    </div>
  </div>
  <div class="row">
    <div class="col-md-6">
      <input style="display: none;" name="other-text" type="text" class="form-control" value="" placeholder="Please state how you found out about us.">
    </div>
  </div>
  <div class="row">
    <div class="col-md-6">
      <label for="first_name" class="form-label">First Name</label>
      <input type="text" class="form-control" name="first_name" id="first_name" placeholder="Your first name" value="" required="required">
    </div>
    <div class="col-md-6">
      <label for="last_name" class="form-label">Last Name</label>
      <input type="text" class="form-control" name="last_name" id="last_name" placeholder="Your last name" value="" required="required">
    </div>
  </div>
  <div class="row">
    <div class="col-md-6">
      <label for="email" class="form-label">Email</label>
      <input type="email" class="form-control" name="email" id="email" placeholder="Your email address" value="" required="required">
    </div>
    <div class="col-md-6">
      <label for="phone" class="form-label">Phone</label>
      <input type="tel" class="form-control" name="phone" id="phone" placeholder="Your phone number" required="required">
    </div>
  </div>
  <div class="row">
    <div class="col-md-6">
      <label for="street" class="form-label">Street</label>
      <input type="text" class="form-control" name="street" id="street" placeholder="1600 Pennsylvania Ave" value="" required="required">
    </div>
    <div class="col-md-6">
      <label for="city" class="form-label">City</label>
      <input type="text" class="form-control" name="city" id="city" placeholder="Washington" value="" required="required">
    </div>
  </div>
  <div class="row">
    <div class="col-md-6">
      <label for="state" style="display: block;" class="form-label">State</label>
      <select name="state" id="state" class="form-select" required="required">
        <option value="">Choose...</option>
        <option value="AL">Alabama</option>
        <option value="AK">Alaska</option>
        <option value="AZ">Arizona</option>
        <option value="AR">Arkansas</option>
        <option value="CA">California</option>
        <option value="CO">Colorado</option>
        <option value="CT">Connecticut</option>
        <option value="DE">Delaware</option>
        <option value="DC">District of Columbia</option>
        <option value="FL">Florida</option>
        <option value="GA">Georgia</option>
        <option value="HI">Hawaii</option>
        <option value="ID">Idaho</option>
        <option value="IL">Illinois</option>
        <option value="IN">Indiana</option>
        <option value="IA">Iowa</option>
        <option value="KS">Kansas</option>
        <option value="KY">Kentucky</option>
        <option value="LA">Louisiana</option>
        <option value="ME">Maine</option>
        <option value="MD">Maryland</option>
        <option value="MA">Massachusetts</option>
        <option value="MI">Michigan</option>
        <option value="MN">Minnesota</option>
        <option value="MS">Mississippi</option>
        <option value="MO">Missouri</option>
        <option value="MT">Montana</option>
        <option value="NE">Nebraska</option>
        <option value="NV">Nevada</option>
        <option value="NH">New Hampshire</option>
        <option value="NJ">New Jersey</option>
        <option value="NM">New Mexico</option>
        <option value="NY">New York</option>
        <option value="NC">North Carolina</option>
        <option value="ND">North Dakota</option>
        <option value="OH">Ohio</option>
        <option value="OK">Oklahoma</option>
        <option value="OR">Oregon</option>
        <option value="PA">Pennsylvania</option>
        <option value="RI">Rhode Island</option>
        <option value="SC">South Carolina</option>
        <option value="SD">South Dakota</option>
        <option value="TN">Tennessee</option>
        <option value="TX">Texas</option>
        <option value="UT">Utah</option>
        <option value="VT">Vermont</option>
        <option value="VA">Virginia</option>
        <option value="WA">Washington</option>
        <option value="WV">West Virginia</option>
        <option value="WI">Wisconsin</option>
        <option value="WY">Wyoming</option>
      </select>
    </div>
    <div class="col-md-6">
      <label for="zip" class="form-label">Zip</label>
      <input type="text" class="form-control" name="zip" id="zip" placeholder="20500" value="" required="required">
    </div>
  </div>
</form>

Text Content

MAIN NAVIGATION

Citizens Academy US
 * Become a Leader


BECOME A LEADER

 1. Fill in all sections in the form below.
 2. Press the Submit button.
 3. Check your email.
 4. Download the Guide to Complete Understanding.

--------------------------------------------------------------------------------

How did you find out about us? Choose... By a friend. I heard about it at a
meeting. I received a Citizens Academy service. Other...

First Name
Last Name
Email
Phone
Street
City
State Choose... Alabama Alaska Arizona Arkansas California Colorado Connecticut
Delaware District of Columbia Florida Georgia Hawaii Idaho Illinois Indiana Iowa
Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota
Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico
New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode
Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia
Washington West Virginia Wisconsin Wyoming
Zip
Receive additional information by email?
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