@extends('frontend.layouts.master')
@section('content')
    <div class="page-banner-area" style="background: url({{ asset("$breadcrumb->name") }});">
        <div class="container">
            <div class="page-banner-content">
                <h1>{{ $page_name }}</h1>
                <ul>
                    <li><a title="Home" href="{{ url('/') }}">Home</a></li>
                    <li>{{ $page_name }}</li>
                </ul>
            </div>
        </div>
        <img src="{!! asset('public/frontend/images/wave21.svg') !!}" alt="Image" class="top_wave_img">
    </div>

    <div class="contact-us-area pt-100 pb-70">
        <div class="container">
            <div class="row">
                <div class="col-lg-12">
                    <div class="contacts-form">
                        <h3>Apply For Scholarship</h3>
                        {!! Form::open([
                            'admission-form-submission' => 'form',
                            'url' => 'admission-form-submission',
                            'files' => true,
                            'class' => 'contact_form wrap-form pt-15 clearfix',
                        ]) !!}
                        <div class="row">
                            <div class="col-lg-4 col-sm-6">
                                <div class="form-group">
                                    <label>Your name</label>
                                    <input type="text" name="name" id="name" class="form-control" required
                                        data-error="Please enter your name">
                                    <div class="help-block with-errors"></div>
                                </div>
                            </div>
                            <!--<div class="col-lg-4 col-sm-6">
                                <div class="form-group">
                                    <label>Gender</label>
                                    <select name="gender" id="gender" class="form-control" required
                                        data-error="Please select your Gender">
                                        <option value="">-- Select Gender --</option>
                                        <option value="male">Male</option>
                                        <option value="female">Female</option>
                                        <option value="others">Others</option>
                                    </select>
                                    <div class="help-block with-errors"></div>
                                </div>
                            </div>

                            <div class="col-lg-4 col-sm-6">
                                <div class="form-group">
                                    <label>Your email</label>
                                    <input type="email" name="email" id="email" class="form-control" required
                                        data-error="Please enter your email">
                                    <div class="help-block with-errors"></div>
                                </div>
                            </div>-->
                            <div class="col-lg-4 col-sm-6">
                                <div class="form-group">
                                    <label>Your phone</label>
                                    <input type="text" name="phone" id="phone" required
                                        data-error="Please enter your number" class="form-control">
                                    <div class="help-block with-errors"></div>
                                </div>
                            </div>

                            
                            <div class="col-lg-4 col-sm-6">
                                <div class="form-group">
                                    <label>Program Name</label>
                                    <select name="subject" id="subject" class="form-control" required
                                        data-error="Please enter your subject">
                                        <option value="">-- Select Department --</option>
                                        @foreach ($schools as $school)
                                            <option value="{{ $school->id }}">{{ $school->name }}</option>
                                        @endforeach
                                    </select>
                                    <div class="help-block with-errors"></div>
                                </div>
                            </div>
                            <div class="col-lg-4 col-sm-6">
                                <div class="form-group">
                                    <label>SSC Roll</label>
                                    <input type="text" name="father_name" id="father_name" class="form-control"
                                        data-error="Please enter your SSC Roll">
                                    <div class="help-block with-errors"></div>
                                </div>
                            </div>
                            <div class="col-lg-4 col-sm-6">
                                <div class="form-group">
                                    <label>SSC Registration No</label>
                                    <input type="text" name="mother_name" id="mother_name" required
                                        data-error="Please enter your SSC Registration No" class="form-control">
                                    <div class="help-block with-errors"></div>
                                </div>
                            </div>
                            <div class="col-lg-4 col-sm-6">
                                <div class="form-group">
                                    <label>SSC Passing Year</label>
                                    <input type="number" name="ssc_passing_year" id="ssc_passing_year" min="1970"
                                        max="{{ date('Y') }}" class="form-control" required
                                        data-error="Please enter your SSC passing Year">
                                    <div class="help-block with-errors"></div>
                                </div>
                            </div>
                            <div class="col-lg-4 col-sm-6">
                                <div class="form-group">
                                    <label>SSC Board Name</label>
                                    <select name="ssc_institute" id="ssc_institute" class="form-control" required
                                        data-error="Please enter your SSC Board Name">
                                        <option value="">-- Select SSC Board Name --</option>
                                            <option value="Dhaka">Dhaka</option>
                                            <option value="Rajshahi">Rajshahi</option>
                                            <option value="Comilla">Comilla</option>
                                            <option value="Jashore">Jashore</option>
                                            <option value="Chattogram">Chattogram</option>
                                            <option value="Barisal">Barisal</option>
                                            <option value="Sylhet">Sylhet</option>
                                            <option value="Technical">Technical</option>
                                            <option value="Madrasah">Madrasah</option>
                                    </select>
                                    <div class="help-block with-errors"></div>
                                </div>
                            </div>

                            
                            <!--<div class="col-lg-4 col-sm-6">
                                <div class="form-group">
                                    <label>SSC GPA</label>
                                    <input type="number" name="ssc_gpa" min="2" max="5" step="any"
                                        id="ssc_gpa" required data-error="Please enter your SSC GPA"
                                        class="form-control">
                                    <div class="help-block with-errors"></div>
                                </div>
                            </div>

                            <div class="col-lg-4 col-sm-6">
                                <div class="form-group">
                                    <label>HSC / Diploma Institute Name</label>
                                    <input type="text" name="hsc_institute" id="hsc_institute" required
                                        data-error="Please enter your HSC Institute Name" class="form-control">
                                    <div class="help-block with-errors"></div>
                                </div>
                            </div>

                            <div class="col-lg-4 col-sm-6">
                                <div class="form-group">
                                    <label>HSC / Diploma Passing Year</label>
                                    <input type="number" name="hsc_passing_year" id="hsc_passing_year" min="1970"
                                        max="{{ date('Y') }}" class="form-control" required
                                        data-error="Please enter your HSC passing year">
                                    <div class="help-block with-errors"></div>
                                </div>
                            </div>
                            <div class="col-lg-4 col-sm-6">
                                <div class="form-group">
                                    <label>HSC / Diploma GPA</label>
                                    <input type="number" name="hsc_gpa" min="2" max="5" step="any"
                                        id="hsc_gpa" required data-error="Please enter your HSC GPA"
                                        class="form-control">
                                    <div class="help-block with-errors"></div>
                                </div>
                            </div>

                            <div class="col-lg-4 col-sm-6">
                                <div class="form-group">
                                    <label>Bachelor Institute Name</label>
                                    <input type="text" name="b_institute" id="b_institute"
                                        data-error="Please enter your bachelor Institute Name" class="form-control">
                                    <div class="help-block with-errors"></div>
                                </div>
                            </div>

                            <div class="col-lg-4 col-sm-6">
                                <div class="form-group">
                                    <label>Bachelor Passing Year</label>
                                    <input type="number" name="b_passing_year" id="b_passing_year" min="1970"
                                        max="{{ date('Y') }}" class="form-control"
                                        data-error="Please enter your bachelor passing year">
                                    <div class="help-block with-errors"></div>
                                </div>
                            </div>
                            <div class="col-lg-4 col-sm-6">
                                <div class="form-group">
                                    <label>Bachelor CGPA</label>
                                    <input type="number" name="b_gpa" min="1" max="4" step="any"
                                        id="b_gpa" data-error="Please enter your bachelor CGPA" class="form-control">
                                    <div class="help-block with-errors"></div>
                                </div>
                            </div>

                            <div class="col-12">
                                <div class="form-group">
                                    <label>Note (If Needed)</label>
                                    <textarea name="message" class="form-control" id="message" cols="30" rows="3"
                                        data-error="Write your message"></textarea>
                                    <div class="help-block with-errors"></div>
                                </div>
                            </div>-->
                            <div class="col-lg-12 col-md-12">
                                <button type="submit" class="default-btn">
                                    <span>Apply Now</span>
                                </button>
                                <div id="msgSubmit" class="h3 text-center hidden"></div>
                                <div class="clearfix"></div>
                            </div>
                        </div>
                        {!! Form::close() !!}
                    </div>
                </div>
            </div>
        </div>
    </div>
@endsection