@include('_partials_admin.head')
<!-- Page content -->
<div class="page-content">


	<!-- Main content -->
	<div class="content-wrapper">


		<!-- Content area -->
		<div class="content pt-0">

			<!-- Basic responsive configuration -->
			<div class="card col-md-6 mt-5 mx-auto d-block">
				<div class="card-body">
					<form action="/Frontend/Form/tambahDiploma" class="form-validate-jquery" method="POST" enctype="multipart/form-data">

						{{ csrf_field() }}
						<div class="col-md-12">
							<fieldset>
								<legend class="font-weight-semibold text-center">APPLICATION FORM<br>
								UNI-BRIDGE DIPLOMA PROGRAM IN ASSOCIATION WITH <br>STMIK LIKMI - SCHOOL OF BUSINESS & IT</legend>

								<div class="form-group">
									<p class="font-weight-bold">PERSONAL DETAILS:</p>
								</div>
								
								<div class="form-group">
									<label>Enter your name:<span class="text-danger">*</span></label>
									<input type="text" class="form-control" name="nama_lengkap" placeholder="Full name" required value="{{ old('nama_lengkap') }}">
								</div>

								<div class="form-group">
									<label>Gender:<span class="text-danger">*</span></label>
									<select class="form-control" name="gender" required>
										<option value="" selected="" disabled="">Choose your gender</option>
										<option value="Male">Male</option>
										<option value="Female">Female</option>
									</select>
								</div>

								<div class="form-group">
									<label>Enter your place of birthday:<span class="text-danger">*</span></label>
									<input type="text" class="form-control" name="tempat_lahir" placeholder="Place of birth" value="{{ old('tempat_lahir') }}" required>
								</div>

								<div class="form-group">
									<div class="input-group">
										<span class="input-group-prepend">
											<span class="input-group-text">Enter your birthday:<span class="text-danger">*</span></span>
										</span>
										<input type="text" class="form-control pickadate-accessibility picker__input" name="tanggal_lahir" value="{{ old('tanggal_lahir') }}" placeholder="Date of birth" required>
									</div>
								</div>

								<div class="form-group">
									<label>Enter your home phone number:<span class="text-danger">*</span></label>
									<input type="text" class="form-control" name="telepon_rumah" placeholder="Home phone number" value="{{ old('telepon_rumah') }}" required>
								</div>

								<div class="form-group">
									<label>Enter your mobile number:<span class="text-danger">*</span></label>
									<input type="text" class="form-control" name="nomor_telepon" placeholder="Mobile number" value="{{ old('nomor_telepon') }}" required>
								</div>

								<div class="form-group">
									<label>Enter your email address:<span class="text-danger">*</span></label>
									<input type="email" class="form-control" name="email" placeholder="Email address" value="{{ old('email') }}" required>
								</div>

								<div class="form-group">
									<label>Home address:<span class="text-danger">*</span></label>
									<textarea class="form-control" name="alamat" required>{{ old('alamat') }}</textarea>
								</div>

								<div class="form-group">
									<label class="font-weight-bold">ACADEMIC BACKGROUND:</label>
								</div>

								<div class="form-group">
									<label>Name of previous school:<span class="text-danger">*</span></label>
									<input type="text" class="form-control" name="educational" placeholder="Name of previous school" value="{{ old('educational') }}" required>
								</div>

								<div class="form-group">
									<label>Address of previous school:<span class="text-danger">*</span></label>
									<input type="text" class="form-control" name="address_school" placeholder="Address of previous school" value="{{ old('address_school') }}" required>
								</div>

								<div class="form-group">
									<label>Curriculum used:<span class="text-danger">*</span></label>
									<input type="text" class="form-control" name="curriculum" placeholder="Curriculum used" value="{{ old('curriculum') }}" required>
								</div>

								<div class="form-group">
									<label>What is your current qualification:<span class="text-danger">*</span></label>
									<textarea class="form-control" name="qualification" required>{{ old('qualification') }}</textarea>
								</div>

								<div class="form-group">
									<label class="font-weight-bold">PARENTS/ GUARDIAN DETAILS:</label>
								</div>

								<span class="font-weight-semibold">Father</span>
								<hr>
								<div class="form-group ml-4">
									<label>Enter name:<span class="text-danger">*</span></label>
									<input type="text" class="form-control" name="nama_ayah" placeholder="Full name" value="{{ old('nama_ayah') }}" required>
								</div>
								<div class="form-group ml-4">
									<label>Enter mobile number:<span class="text-danger">*</span></label>
									<input type="text" class="form-control" name="nomor_ayah" placeholder="Mobile number" value="{{ old('nomor_ayah') }}" required>
								</div>
								<div class="form-group ml-4">
									<label>Enter email address:<span class="text-danger">*</span></label>
									<input type="email" class="form-control" name="email_ayah" placeholder="Email address" value="{{ old('email_ayah') }}" required>
								</div>

								<span class="font-weight-semibold">Mother</span>
								<hr>
								<div class="form-group ml-4">
									<label>Enter name:<span class="text-danger">*</span></label>
									<input type="text" class="form-control" name="nama_ibu" placeholder="Full name" value="{{ old('nama_ibu') }}" required>
								</div>
								<div class="form-group ml-4">
									<label>Enter mobile number:<span class="text-danger">*</span></label>
									<input type="text" class="form-control" name="nomor_ibu" placeholder="Mobile number" value="{{ old('nomor_ibu') }}" required>
								</div>
								<div class="form-group ml-4">
									<label>Enter email address:<span class="text-danger">*</span></label>
									<input type="text" class="form-control" name="email_ibu" placeholder="Email address" value="{{ old('email_ibu') }}" required>
								</div>

								<span class="font-weight-semibold">Guardian (if opted):</span>
								<hr>
								<div class="form-group ml-4">
									<label>Enter name:</label>
									<input type="text" class="form-control" name="nama_wali" placeholder="Full name" value="{{ old('nama_wali') }}">
								</div>
								<div class="form-group ml-4">
									<label>Enter mobile number:</label>
									<input type="text" class="form-control" name="nomor_wali" placeholder="Mobile number" value="{{ old('nomor_wali') }}">
								</div>
								<div class="form-group ml-4">
									<label>Enter email address:</label>
									<input type="email" class="form-control" name="email_wali" placeholder="Email address" value="{{ old('email_wali') }}">
								</div>

								<div class="form-group">
									<label>Address (if different from main address):</label>
									<textarea class="form-control" name="alamat_2">{{ old('alamat_2') }}</textarea>
								</div>

								<div class="form-group">
									<table class="table table-bordered table-responsive">
										<tr>
											<th colspan="5">UNI-BRIDGE DIPLOMA PROGRAM IN ASSOCIATION WITH STMIK LIKMI - SCHOOL OF BUSINESS & IT<span class="text-danger">*</span></th>
										</tr>

										<br>
										<tr>
											<td rowspan="2" width="1px">1</td>
											<th colspan="3">Version 1 – 4 subjects in Indonesia</th>
											<td colspan="1">
												<label for="chkNo">
													<input type="radio" name="program" id="chkNo" value="1">
												</label>
											</td>
										</tr>
										<tr>
											<td colspan="4">Then continue to Canning College for semester 2 of Diploma of Commerce leading to Bachelor of Commerce at Curtin University – Western Australia</td>
										</tr>

										<tr>
											<td rowspan="18" width="1px">2</td>
											<th colspan="3">Version 2 – 8 subjects in Indonesia</th>
											<td colspan="1">
												<label for="chkYes">
													<input type="radio" name="program" id="chkYes" value="2" checked>
												</label>
											</td>
										</tr>

										<tr>
											<th colspan="4">
												<select class="form-control" name="country" id="country">
													<option value="0" disabled="" selected="">Choose Country</option>
													<option value="AUSTRALIA">AUSTRALIA</option>
													<option value="INDONESIA">INDONESIA</option>
													<option value="SINGAPORE">SINGAPORE</option>
												</select>
											</th>
										</tr>

										<tr>
											<th colspan="4" >
												<select class="form-control" name="campus" id="campus">	<option value="" disabled="" selected="">Choose Institution</option>
												</select>
											</th>
										</tr>

										<tr>
											<th colspan="4">
												<select class="form-control" name="city" id="city" >
													<option value="" disabled="" selected="">Choose Location</option>

												</select>
											</th>
										</tr>

									</table>
								</div>

								<div class="form-group">
									<label class="font-weight-bold">Please find attached the following document:</label>
								</div>

								<div class="form-group">
									<label>School report – Year 12 (Semester 1 & 2):<span class="text-danger">*</span></label>
									<input type="file" class="form-control @error('document')is-invalid @enderror" name="document" required>
									<p class="font-italic text-info">(Max: 1MB, Type: JPG/PDF)</p>
									@error('document')<p class="text-danger">{{ $message }}</p>@enderror
								</div>

								<div class="form-group">
									<label>Senior High School Certificate of Completion:<span class="text-danger">*</span></label>
									<input type="file" class="form-control @error('document2')is-invalid @enderror" name="document2" required>
									<p class="font-italic text-info">(Max: 1MB, Type: JPG/PDF)</p>
									@error('document2')<p class="text-danger">{{ $message }}</p>@enderror
								</div>

								<div class="form-group">
									<label>Proof of English proficiency equivalent o IELTS 5,0 (overall band):</label>
									<input type="file" class="form-control @error('document3')is-invalid @enderror" name="document3">
									<p class="font-italic text-info">(Max: 1MB, Type: JPG/PDF)</p>
									@error('document3')<p class="text-danger">{{ $message }}</p>@enderror
								</div>

								<div class="form-group">
									<label>Copy of passport (personal page only) and ID Card:<span class="text-danger">*</span></label>
									<input type="file" class="form-control @error('document4')is-invalid @enderror" name="document4" required>
									<p class="font-italic text-info">(Max: 1MB, Type: JPG/PDF)</p>
									@error('document4')<p class="text-danger">{{ $message }}</p>@enderror
								</div>

								<div class="form-group">
									<label>Copy of family registration card:<span class="text-danger">*</span></label>
									<input type="file" class="form-control @error('document5')is-invalid @enderror" name="document5" required>
									<p class="font-italic text-info">(Max: 1MB, Type: JPG/PDF)</p>
									@error('document5')<p class="text-danger">{{ $message }}</p>@enderror
								</div>

							</fieldset>
							<p class="text-right font-italic"><span class="text-danger">*</span>required</p>
							<ul class="mb-3 mt-3">
								<li>I hereby acknowledge that all of the above information provided to Uni-bridge, is true to the best of my knowledge.</li>
								<li>I further allow Uni-bridge to carry further assessment on the above information should it prove to be necessary.</li>
								<li>I also allow Uni-bridge to process my application to the institution & program overseas that I have selected.</li>
							</ul>

							25 Sep 2026						</div>

						<div class="text-right">
							<button type="submit" class="btn btn-primary">Submit form <i class="icon-paperplane ml-2"></i></button>
						</div>
					</form>
				</div>
			</div>
			<!-- /basic responsive configuration -->

		</div>
		<!-- /content area -->
	</div>
	<!-- /main content -->

</div>
<!-- /page content -->
<script type="text/javascript" src="http://ajax.googleapis.com/ajax/libs/jquery/1.8.3/jquery.min.js"></script>
<script type="text/javascript">
    $(function () {
        $("input[name='program']").click(function () {
            if ($("#chkYes").is(":checked")) {
                $("#country").removeAttr("disabled");
                $("#country").focus();
                $("#campus").removeAttr("disabled");
                $("#campus").focus();
                $("#city").removeAttr("disabled");
                $("#city").focus();
            } else {
                $("#country").attr("disabled", "disabled");
                $("#campus").attr("disabled", "disabled");
                $("#city").attr("disabled", "disabled");
            }
        });
    });
</script>
<script type="text/javascript">
	$(document).ready(function(){
		$('#country').change(function(){
			select_country();
		});
		$('#campus').change(function(){
			select_campus();
		});
	});

	function select_country(){
		var contry = $('#country').val();
		if (contry == 'AUSTRALIA') {
			$('#campus').html('<option value="0" disabled="" selected="">Choose Institution</option><option value="Kaplan Business School (KBS)">Kaplan Business School (KBS)</option><option value="Melbourne Institute of Technology (MIT)">Melbourne Institute of Technology (MIT)</option><option value="RMIT University">RMIT University</option>');
		}else if(contry == 'INDONESIA'){
			$('#campus').html('<option value="0" disabled="" selected="">Choose Institution</option><option value="STMIK LIKMI">STMIK LIKMI</option>');
		}else if(contry == 'SINGAPORE'){
			$('#campus').html('<option value="0" disabled="" selected="">Choose Institution</option><option value="University College Dublin - Ireland">University College Dublin - Ireland</option><option value="Royal Holloway, University of London">Royal Holloway, University of London</option><option value="University De Montfort – United Kingdom">University De Montfort – United Kingdom</option><option value="Queen Margaret University – United Kingdom">Queen Margaret University – United Kingdom</option>');
		}
	}

	function select_campus(){
		var kota  = $('#campus').val();
		if (kota == 'Kaplan Business School (KBS)'){
			$('#city').html('<option value="0" disabled="" selected="">Choose Location</option><option value="Adelaide">Adelaide</option><option value="Brisbane">Brisbane</option><option value="Melbourne">Melbourne</option></option><option value="Sydney">Sydney</option>');
		}else if(kota == 'Melbourne Institute of Technology (MIT)'){
			$('#city').html('<option value="0" disabled="" selected="">Choose Location</option><option value="Melbourne">Melbourne</option></option><option value="Sydney">Sydney</option>');
		}else if(kota == 'RMIT University'){
			$('#city').html('<option value="0" disabled="" selected="">Choose Location</option><option value="Melbourne">Melbourne</option>');
		}else if(kota == 'STMIK LIKMI'){
			$('#city').html('<option value="0" disabled="" selected="">Choose Location</option><option value="Bandung">Bandung</option>');
		}else if(kota == 'University College Dublin - Ireland'){
			$('#city').html('<option value="0" disabled="" selected="">Choose Location</option><option value="Kaplan Singapore">Kaplan Singapore</option>');
		}else if(kota == 'Royal Holloway, University of London'){
			$('#city').html('<option value="0" disabled="" selected="">Choose Location</option><option value="Kaplan Singapore">Kaplan Singapore</option>');
		}else if(kota == 'University De Montfort – United Kingdom'){
			$('#city').html('<option value="0" disabled="" selected="">Choose Location</option><option value="(EASB) East Asia Institute of Management">(EASB) East Asia Institute of Management</option>');
		}else if(kota == 'Queen Margaret University – United Kingdom'){
			$('#city').html('<option value="0" disabled="" selected="">Choose Location</option><option value="(EASB) East Asia Institute of Management">(EASB) East Asia Institute of Management</option>');
		}
	}
</script>

@if ($message = Session::get('sukses'))
<script type="text/javascript">
	$(document).ready(function () {
		new Noty(
			{text: 'Data telah disimpan.', type: 'success'}
			).show();
	});
</script>
@elseif (Session::get('gagal'))
<script type="text/javascript">
	$(document).ready(function () {
		new Noty(
			{text: 'Data gagal disimpan.', type: 'error'}
			).show();
	});
</script>
@elseif (Session::get('gagal_foreign'))
<script type="text/javascript">
	$(document).ready(function () {
		new Noty(
			{text: 'Data gagal dihapus, karena masih terhubung dengan data yang lain.', type: 'error'}
			).show();
	});
</script>
@endif

</body>
</html>