@extends('layouts/default')

{{-- Page title --}}
@section('title')
    Register
    @parent
@stop
{{-- page level styles --}}
@section('header_styles')
    <link href="{{ asset('assets/css/pages/alertmessage.css') }}" rel="stylesheet" />
    <link href="{{ asset('assets/css/pages/mail_box.css') }}" rel="stylesheet" type="text/css" />
    <link href="{{ asset('assets/js/pages/jquery.multiselect.css')}}" rel="stylesheet" type="text/css">
    <style>
        body {
        }
    </style>
@stop
<script type="text/javascript" src="{{ asset('assets/css/pages/tinymce/jscripts/tiny_mce/tiny_mce.js') }}"></script>
<script type="text/javascript">
    tinyMCE.init({
        // General options
        mode : "textareas",
        theme : "advanced",
        plugins : "pagebreak,style,layer,table,save,advhr,advimage,advlink,emotions,iespell,inlinepopups," +
        "insertdatetime,preview,media,searchreplace,print,contextmenu,paste,directionality,fullscreen,noneditable," +
        "visualchars,nonbreaking,xhtmlxtras,template,wordcount",
        // Theme options
//            theme_advanced_buttons1 : "save,newdocument,|,bold,italic,underline,|,justifyleft,justifycenter,justifyright," +
//                    "justifyfull,formatselect,fontselect,fontsizeselect,table,bullist,numlist,|,outdent,indent," +
//            "|,undo,redo,|,link,unlink,cleanup,code,|,insertdate,inserttime,|,forecolor,backcolor",
        theme_advanced_buttons1 : "save,newdocument,|,bold,italic,underline,|,justifyleft,justifycenter,justifyright," +
        "justifyfull,formatselect,fontselect,fontsizeselect,table,bullist,numlist,|,outdent,indent," +
        "|,link,unlink,cleanup,code,|,forecolor,backcolor",
        theme_advanced_toolbar_location : "top",
        theme_advanced_toolbar_align : "left",
        theme_advanced_statusbar_location : "bottom",
        theme_advanced_resizing : true,
        // Example content CSS (should be your site CSS)
        content_css : "css/content.css",
        // Drop lists for link/image/media/template dialogs
        template_external_list_url : "lists/template_list.js",
        external_link_list_url : "lists/link_list.js",
        external_image_list_url : "lists/image_list.js",
        media_external_list_url : "lists/media_list.js",
        // Replace values for the template plugin
        template_replace_values : {
            username : "Some User",
            staffid : "991234"
        }
    });
</script>
{{--<script type="text/javascript" src="http://ajax.googleapis.com/ajax/libs/jquery/1.8.3/jquery.min.js"></script>--}}
<script type="text/javascript" src="{{ asset('assets/js/pages/jquery.min.js') }}"></script>
{{--///////////////////////////////////////////////////////--}}
<script type="text/javascript">
    $(function () {
        $("#zone").change(function () {
            if ($(this).val() == "other") {
                $("#block").show();

            } else {
                $("#block").hide();
                $("#gate").hide();

            }
        });
    });
</script>
<script type="text/javascript">
    $(function () {
        $("#block").change(function () {
            if ($(this).val() == "") {
                $("#gate").show();

            } else {
                $("#gate").hide();

            }
        });
    });
</script>
{{--/////////////////////////////////////////////////////////--}}

<script type="text/javascript">
    $(function () {
        $("#woreda").change(function () {
            if ($(this).val() == "other") {
                $("#block1").show();

            } else {
                $("#block1").hide();
                $("#gate").hide();

            }
        });
    });
</script>
<script type="text/javascript">
    $(function () {
        $("#block1").change(function () {
            if ($(this).val() == "") {
                $("#gate").show();

            } else {
                $("#gate").hide();

            }
        });
    });
</script>


<script type="text/javascript">
    $(function () {
        $("#city").change(function () {
            if ($(this).val() == "other") {
                $("#block2").show();

            } else {
                $("#block2").hide();
                $("#gate").hide();

            }
        });
    });
</script>
<script type="text/javascript">
    $(function () {
        $("#block2").change(function () {
            if ($(this).val() == "") {
                $("#gate").show();

            } else {
                $("#gate").hide();

            }
        });
    });
</script>
{{-- Page content --}}
@section('content')
@section('top')
    <div class="breadcum">
        <div class="container">
            <ol class="">
                <center><h3><font color="blue">Official Reqeust Form</font></h3></center>
                </li>
            </ol>
        </div>
    </div>
@stop
<!-- Main content -->
<section class="content">
    <div class="col-lg-16 col-md-12 col-sm-12">
        <div class="whitebg">

            <table class="table table-striped table-advance table-hover" id="inbox-check" border="0" >
                <tbody>
                {!! Form::open(['url' => 'officialregister','files'=>'true']) !!}
                {{--<form id="commentForm" action="{{ URL('officailreqeust') }}"--}}
                {{--method="POST" enctype="multipart/form-data" class="form-horizontal">--}}

                <!-- CSRF Token -->
                <input type="hidden" name="_token" value="{{ csrf_token() }}" />
                <tr> <div class="form-group">
                        <td><label for="first_name" class="col-sm-15 control-label">First Name</label></td>


                        <td colspan="">
                            {!! Form::text('fname', null, ['class' => 'form-control','required','placeholder' => 'Your Name']) !!} </td>
                        <td><label for="Middle_name" class="col-sm-15 control-label">Middle Name</label></td>
                        <td colspan="">
                            {!! Form::text('mname', null, ['class' => 'form-control','required','placeholder' => 'Middle Name']) !!} </td>
                        <td><label for="last_name" class="col-sm-15 control-label">Last Name</label></td>
                        <td colspan="">
                            {!! Form::text('lname', null, ['class' => 'form-control','required','placeholder' => 'Father Name']) !!} </td>
                        {{--</div>--}}
                    </div>
                </tr>
                <tr> <div class="form-group">
                        <td><label for="birthdate" class="col-sm-15 control-label">Graduation Date</label></td>
                        <td colspan="">
                            {!! Form::date('birthdate', null, ['class' => 'form-control',' ','placeholder' => 'birth date']) !!}
                        </td>


                        <td><label for="sex" class="col-sm-15 control-label">Sex</label></td>
                        <td colspan="">
                            <select name="sex" class="form-control" required>
                                <option value="">Select Sex</option>
                                <option value="Male">Male</option>
                                <option value="Female">Female</option>
                            </select>

                        </td>
                        <td><label for="first_name" class="col-sm-15 control-label">Email</label></td>
                        <td colspan="">
                            {!! Form::text('email', null, ['class' => 'form-control','required','placeholder' => 'Email Address']) !!}
                        </td>
                    </div>
                </tr>
                <tr>




                    <style>
                        body {
                            font-family: Arial, sans-serif;

                        }
                        .radio-group {
                            display: flex;
                            align-items: left;

                        }
                        .radio-group label {

                        }
                    </style>
                    </head>
                    <body>
                    <form>
                        <td><label>Admision Type</label></td>

                        <td><div class="radio-group" name="admision">
                                <label>
                                    <input type="radio" name="admision" value="regular">
                                    Regular
                                </label>
                                <label>
                                    <input type="radio" name="admision" value="extension">
                                    Extesnion
                                </label>
                                <label>
                                    <input type="radio" name="admision" value="summer">
                                    Summer
                                </label>

                            </div>

                        </td>

                        <td><label for="first_name" class="col-sm-15 control-label">Degree Type</label></td>

                        <td> <div class="radio-group">
                                <style>
                                    /* Style for the form and labels */
                                    .radio-group {
                                        display: flex;         /* Use flexbox for horizontal layout */
                                        gap: 20px;            /* Space between radio buttons */
                                    }

                                    label {
                                        cursor: pointer;      /* Pointer cursor on hover */
                                    }
                                </style>
                                <label>
                                    <input type="radio" name="degreetype" value="firstdegree">
                                    First Degree
                                </label>
                                <label>
                                    <input type="radio" name="degreetype" value="msc">
                                    MSC
                                </label>
                                <label>
                                    <input type="radio" name="degreetype" value="phd">
                                    PHD
                                </label>
                                <label>
                                    <input type="radio" name="degreetype" value="diploma">
                                    Diploma
                                </label>
                            </div>

                        </td>

                </tr>
                <tr>
                    <td><label for="first_name" class="col-sm-15 control-label"> Name of Institution </label></td>
                    <td colspan="">
                        {!! Form::text('reciever', null, ['class' => 'form-control','required','placeholder' => 'Instituion Name ']) !!}
                    </td>
                    <td><label for="first_name" class="col-sm-15 control-label">Postal Code</label></td>
                    <td colspan="">
                        {!! Form::text('postal', null, ['class' => 'form-control','required','placeholder' => 'Postal Code']) !!}
                    </td>

                    <td><!DOCTYPE html>
                        <html lang="en">

                        <style>
                            body {
                                font-family: Arial, sans-serif;
                                margin: 20px;
                            }
                            select {
                                padding: 10px;
                                border: 1px solid #ccc;
                                border-radius: 4px;
                                width: 200px;
                                box-sizing: border-box;
                            }
                        </style>

                        <body>
                        <label for="options">Mailing Type:</label>
                        <select id="options" name="postatype">
                            <option value="">--Select an option--</option>
                            <option value="option1">EMS</option>
                            <option value="option2">DHL</option>
                            <option value="option3">Normal Post 3</option>

                        </select>
                        </body>
                        </html></td>
                    <td><!DOCTYPE html>
                        <html lang="en">

                        <style>
                            body {
                                font-family: Arial, sans-serif;
                                margin: 20px;
                            }
                            select {
                                padding: 10px;
                                border: 1px solid #ccc;
                                border-radius: 4px;
                                width: 200px;
                                box-sizing: border-box;
                            }
                        </style>

                        <body>
                        <label for="options">Request  Type:</label>
                        <select id="options" name="requesttype">
                            <option value="">--Select an Request--</option>
                            <option value="Official">Official</option>
                            <option value="Student Copy">Student Copy</option>
                            <option value="Orginal">Orginal</option>

                        </select>
                        </body>
                        </html></td>
        </div>
        </tr>

        <tr>
            <td><label for="first_name" class="col-sm-15 control-label">College Name</label></td>
            <td colspan="">
                {!! Form::text('collegename', null, ['class' => 'form-control','required','placeholder' => 'College name']) !!}
            </td>
            <td><label for="first_name" class="col-sm-15 control-label">Department </label></td>
            <td colspan="">
                {!! Form::text('department', null, ['class' => 'form-control','required','placeholder' => 'Department Name']) !!}
            </td>

            <td><!DOCTYPE html>
                <html lang="en">



                <body>
                <label for="options">Section:</label>
                <select id="options" name="section">
                    <option value="">--Select an option--</option>
                    <option value="option1">Section A</option>
                    <option value="option2">Section B</option>
                    <option value="option3">Section C</option>

                </select>
                </body>
                </html></td>

        </tr>

        <tr> <td><label for="first_name" class="col-sm-15 control-label">Preparatory Name</label></td>
            <td>
                {!! Form::text('preparatory', null, ['class' => 'form-control','required','placeholder' => 'Preparatory Name']) !!}
            </td>





            <td><label for="first_name" >Documents</label></td>
            <td>
                {!! Form::file('document', null, ['class' => 'form-control','required'=>'required','placeholder'=>'documents']) !!}
            </td>

            <td><label for="first_name" >Cost Sharing</label></td>
            <td>
                {!! Form::file('costsharing', null, ['class' => 'form-control','required'=>'required','placeholder'=>'paymenttype']) !!}
            </td>
        </tr>

        <tr>
            <td><label for="first_name" >Revenue Letter</label></td>

            <td>
                {!! Form::file('revenue', null, ['class' => 'form-control','required'=>'required','placeholder'=>'paymenttype']) !!}
            </td>
        </tr>
        <tr>

            <td><label for="first_name" >Payment Slip</label></td>

            <td>
                {!! Form::file('payment', null, ['class' => 'form-control','required'=>'required','placeholder'=>'paymenttype']) !!}
            </td>


            <td>
                <input type="submit" value="Register"></td></tr>
        </div></div></tr>
    <div><tr>
            <td>

    </div></div>

    </tr>
    </form>
    </tbody>
    </table>

    <hr>
    <b><font color="BLUE">&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;Note:-</font></b>
    <font color="red">Student Must Attach Revenue letter and payment Slip<br>
        &nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; &nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;Payment  = <i>"500 ETB"</i> <br>
        &nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; Account =  <i>"1000101201254"</i></font>

    <br>
    <br>
    <br>
    <br>
    <br>
    </div>

</section>

<!-- content -->
@stop
{{-- page level scripts --}}
@section('footer_scripts')
    <script type="text/javascript">
        $('#slimscrollside').slimscroll({
            height: '700px',
            size: '3px',
            color: 'black',
            opacity: .3
        });
    </script>

    {{--This is for mulit select check box link--}}
    <script src="{{ asset('assets/js/pages/jquery.min.js')}}"></script>
    <script src="{{ asset('assets/js/pages/jquery.multiselect.js') }}"></script>
    {{--<script src="{{ asset('assets/js/pages/todolist.js') }}"></script>--}}
@stop