diff --git a/templates/requests/screen-2.html.to b/templates/requests/screen-2.html.to
index af1dbb74..1b80b06d 100644
--- a/templates/requests/screen-2.html.to
+++ b/templates/requests/screen-2.html.to
@@ -1,84 +1,28 @@
 {% extends '../requests_new.html.to' %}
 
 {% block subtitle %}
-  <h2>Information About You</h2>
+<h2>Information About You</h2>
 {% end %}
 
 {% block form %}
 
 {% autoescape None %}
 {% if f.errors %}
-  <b class="usa-input-error-message">There were some errors, see below.</b>
+<b class="usa-input-error-message">There were some errors, see below.</b>
 {% end %}
 
-<p class="usa-font-lead">Please tell us more about yourself.</p>
+<p class="usa-font-lead">Please tell us more about you.</p>
 
-{{ f.fname_request.label }}
-{{ f.fname_request(placeholder="Your first name") }}
-{% for e in f.fname_request.errors %}
-  <div class="usa-input-error-message">
-    {{ e }}
-  </div>
-{% end %}
+{% module TextInput(f.fname_request) %}
+{% module TextInput(f.lname_request) %}
+{% module TextInput(f.email_request) %}
+{% module TextInput(f.phone_number) %}
 
-{{ f.lname_request.label }}
-{{ f.lname_request(placeholder="Your last name") }}
-{% for e in f.lname_request.errors %}
-  <div class="usa-input-error-message">
-    {{ e }}
-  </div>
-{% end %}
+<p>We want to collect the following information from you for security auditing and determining priviledged user access</p>
 
-{{ f.email_request.label }}
-{{ f.email_request(placeholder="jane@mail.mil") }}
-{% for e in f.email_request.errors %}
-  <div class="usa-input-error-message">
-    {{ e }}
-  </div>
-{% end %}
+{% module TextInput(f.service_branch) %}
+{% module OptionsInput(f.citizenship) %}
+{% module OptionsInput(f.designation) %}
+{% module TextInput(f.date_latest_training) %}
 
-{{ f.phone_number.label }}
-{{ f.phone_number(placeholder="(123) 456-7890") }}
-{% for e in f.phone_number.errors %}
-  <div class="usa-input-error-message">
-    {{ e }}
-  </div>
-{% end %}
-
-{{ f.service_branch.label }}
-{{ f.service_branch(placeholder="i.e. US Air Force, US Army, US Navy, Marine Corps, Defense Media Agency") }}
-{% for e in f.service_branch.errors %}
-  <div class="usa-input-error-message">
-    {{ e }}
-  </div>
-{% end %}
-
-<fieldset class="usa-fieldset-inputs">
-  {{ f.citizenship.label }}
-  {{ f.citizenship(class_="usa-unstyled-list") }}
-{% for e in f.citizenship.errors %}
-  <div class="usa-input-error-message">
-    {{ e }}
-  </div>
-{% end %}
-</fieldset>
-
-<fieldset class="usa-fieldset-inputs">
-  {{ f.designation.label }}
-  {{ f.designation(class_="usa-unstyled-list") }}
-{% for e in f.designation.errors %}
-  <div class="usa-input-error-message">
-    {{ e }}
-  </div>
-{% end %}
-</fieldset>
-
-{{ f.date_latest_training.label }}
-{{ f.date_latest_training }}
-{% for e in f.date_latest_training.errors %}
-  <div class="usa-input-error-message">
-    {{ e }}
-  </div>
-{% end %}
-
-{% end %}
+{% end %}
\ No newline at end of file