document.write("<table border=0 cellspacing=0 cellpadding=2>");
document.write("<form action=\"/city/support/vote.asp?action=ballot&id=3\" method=post>");
document.write("<tr><td align=center height=25><font class=blue><b>城市学院外语视频教学调查问卷<b></font></td></tr>");

document.write("<tr><td><input type=checkbox class=normal name=dataid value=12>英语</td></tr>");

document.write("<tr><td><input type=checkbox class=normal name=dataid value=13>韩语</td></tr>");

document.write("<tr><td><input type=checkbox class=normal name=dataid value=14>日语</td></tr>");

document.write("<tr><td><input type=checkbox class=normal name=dataid value=15>法语</td></tr>");

document.write("<tr><td><input type=checkbox class=normal name=dataid value=16>俄语</td></tr>");

document.write("<tr><td align=center height=25><input type=submit name=_sbt class=btn value=投一票>&nbsp;&nbsp;<a href=\"/city/support/vote.asp?action=view&id=3\">查看结果</a></td></tr>");
document.write("</form></table>");