@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/tambahFoundation" 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 PREPARATION PROGRAM INTO TOP UNIVERSITIES IN THE WORLD</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">
										<tr>
											<th colspan="4">UNI-BRIDGE PREPARATION PROGRAM INTO TOP UNIVERSITIES IN THE WORLD<span class="text-danger">*</span></th>
										</tr>

										<br>
										<tr>
											<td rowspan="2" width="1px">1</td>
											<th colspan="3">ENTRY TO (Select one from the options below):</th>
										</tr>
										<tr>
											<td colspan="3">
												<select class="form-control" name="year" id="year">
													<option value="" selected="" disabled="">Choose year</option>
													<option value="Year 11">Year 11</option>
													<option value="Year 11 (Semester 2)">Year 11 (Semester 2)</option>
												</select>
											</td>
										</tr>

										<tr>
											<td rowspan="2" width="1px">2</td>
											<th colspan="3">SELECTED STREAM (Select one from the options below):</th>
										</tr>
										<tr>
											<td colspan="2">
												<input type="radio" name="stream" value="Science/ Health Science/ Engineering" checked> Science/ Health Science/ Engineering
											</td>
											<td colspan="2">
												<input type="radio" name="stream" value="Business"> Business
											</td>
										</tr>

										<tr>
											<td rowspan="13" width="1px">3</td>
											<th colspan="3">On completion of the program in Indonesia, choose the institution and the country you’ll be continuing your study to :</th>
										</tr>

										<tr>
											<td colspan="3">
												<select name="institution" class="form-control" required id="institution" required>
													<option value="" selected="" disabled="">Choose Institution</option>
													<option value="Canning College – Western Australia">Canning College – Western Australia</option>
													<option value="Bellerbys College – United Kingdom">Bellerbys College – United Kingdom</option>
													<option value="(EASB) East Asia Institute of Management">(EASB) East Asia Institute of Management</option>
													<option value="UP Education">UP Education</option>
												</select>
											</td>
										</tr>

										<tr>
											<td colspan="3">
												<select name="course" class="form-control" required id="course">
													<option value="" selected="" disabled="">Choose Course</option>
												</select>
											</td>
										</tr>

										<tr>
											<td colspan="3">
												<select name="campus" class="form-control" required id="campus">
													<option value="" selected="" disabled="">Choose Location</option>
												</select>
											</td>
										</tr>


									</table>
								</div>

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

								<div class="form-group" id="year11">
									
								</div>

								<div class="form-group">
									<label>Proof of English proficiency equivalent to IELTS 5,0 (overall band) for entry into Year 11:</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>Proof of English proficiency equivalent to IELTS 5,0 (overall band) for entry into Year 11 (Semester 2):</label>
									<input type="file" class="form-control @error('document4')is-invalid @enderror" name="document4">
									<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 passport (personal page only) and ID 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>

								<div class="form-group">
									<label>Copy of family registration card:<span class="text-danger">*</span></label>
									<input type="file" class="form-control @error('document6')is-invalid @enderror" name="document6" required>
									<p class="font-italic text-info">(Max: 1MB, Type: JPG/PDF)</p>
									@error('document6')<p class="text-danger">{{ $message }}</p>@enderror
								</div>

							</fieldset>
							<p class="text-right font-italic"><span class="text-danger">*</span>required</p>
						</div>
						<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>

						24 Sep 2026
						<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">
	$(document).ready(function(){
		$('#institution').change(function(){
			select_institution();
		});
		$('#course').change(function(){
			select_campus();
		});
		$('#year').change(function(){
			select_year();
		});
	});

	function select_institution(){
		var institusi = $('#institution').val();
		if (institusi == 'Canning College – Western Australia') {
			$('#course').html('<option value="0" disabled="" selected="">Choose Course</option><option value="Western Australia Universities Foundation Program (WAUFP)">Western Australia Universities Foundation Program (WAUFP)</option>');
		}else if(institusi == 'Bellerbys College – United Kingdom'){
			$('#course').html('<option value="0" disabled="" selected="">Choose Course</option><option value="Foundation Program">Foundation Program</option><option value="A Level">A Level</option>');
		}else if(institusi == '(EASB) East Asia Institute of Management'){
			$('#course').html('<option value="0" disabled="" selected="">Choose Course</option><option value="Certificate in Business Management">Certificate in Business Management</option>');
		}else if(institusi == 'UP Education'){
			$('#course').html('<option value="0" disabled="" selected="">Choose Course</option><option value="Foundation Studies Programmes">Foundation Studies Programmes</option>');
		}
	}

	function select_campus(){
		var kota  = $('#course').val();
		if (kota == 'Western Australia Universities Foundation Program (WAUFP)'){
			$('#campus').html('<option value="0" disabled="" selected="">Choose Location</option><option value="Perth ">Perth </option>');
		}else if(kota == 'Foundation Program'){
			$('#campus').html('<option value="0" disabled="" selected="">Choose Location</option><option value="Brighton">Brighton</option></option><option value="Cambridge">Cambridge</option><option value="London">London</option>');
		}else if(kota == 'A Level'){
			$('#campus').html('<option value="0" disabled="" selected="">Choose Location</option><option value="Brighton">Brighton</option></option><option value="Cambridge">Cambridge</option><option value="London">London</option>');
		}else if(kota == 'Certificate in Business Management'){
			$('#campus').html('<option value="0" disabled="" selected="">Choose Location</option><option value="Singapore">Singapore</option>');
		}else if(kota == 'Foundation Studies Programmes'){
			$('#campus').html('<option value="0" disabled="" selected="">Choose Location</option><option value=": New Zealand">New Zealand</option>');
		}
	}

	function select_year(){
		var tahun  = $('#year').val();
		if (tahun == 'Year 11'){
			$('#year11').html('<label>School report – Year 10 (Semester 1 & 2) for entry into Year 11:<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');
		}else if(tahun == 'Year 11 (Semester 2)'){
			$('#year11').html('<label>School report – Year 10 (Semester 1 & 2) & Year 11 (Semester 1) for entry into Year 11 (Semester 2):<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');
		}
	}
</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>