<?php

$database = new MySQLDatabase();

$session = new Session();

$user = User::find_by_id($session->id);

?>

<h5 align="center">Select Payment for Transcript Application</h5>

<hr>

<h6 align="center">All Fields are Required</h6>

<form action="" method="POST" class="create_form form-horizontal" >

<!-- Title -->

<?php

$sql_title = "SELECT * FROM title WHERE title_visible=1";

$result = $database->query($sql_title);

?>

<div class="control-group">

<label class="control-label" for="inputTitle">Title</label>

<div class="controls">

<div class="input-prepend">

<span class="add-on"><i class="icon-chevron-down"></i></span>

<select class="input-xlarge" name="title_id" id="title_id" >

<option value="">--Title--</option>

<?php

while($row = $database->fetch_array($result))

{

if($row['title_id'] == $user->title_id)

{

echo '<option selected="selected" value="'. $row['title_id'] .'">'.$row['title_name'].'</option>';

}

else

{

echo '<option value="'. $row['title_id'] .'">'.$row['title_name'].'</option>';

}

}

?>

</select>

</div>

</div>

</div>

<div class="control-group">

<label class="control-label" for="inputEmail">Full Name</label>

<div class="controls">

<div class="input-prepend">

<span class="add-on"><i class="icon-user"></i></span>

<input type="text" class="input-xlarge" required id="full_name" name="full_name" value="<?php if(isset($user->full_name)) echo $user->full_name; ?>" placeholder="Surname, Firstname, middlename" />

</div>

</div>

</div>

<div class="control-group">

<label class="control-label" for="inputEmail">Matriculation Number</label>

<div class="controls">

<div class="input-prepend">

<span class="add-on"><i class="icon-certificate"></i></span>

<input type="text" class="input-xlarge" required id="matriculation_no" name="matriculation_no" value="<?php if(isset($user->matriculation_no)) echo $user->matriculation_no; ?>" placeholder="Matriculation Number" />

</div>

</div>

</div>

<div class="control-group">

<label class="control-label" for="inputEmail"></label>

<div class="controls">

<div class="input-prepend">

<span class="add-on"><i class="iconic-spin"></i></span>

<a href="" class="btn btn-info">Get Matriculation Number ( If Forgotten )</a>

</div>

</div>

</div>

<!-- Gender -->

<?php

$sql_gender = "SELECT * FROM gender WHERE gender_visible=1";

$result_gender = $database->query($sql_gender);

?>

<div class="control-group">

<label class="control-label" for="inputGender">Gender</label>

<div class="controls">

<div class="input-prepend">

<span class="add-on"><i class="icon-chevron-down"></i></span>

<select class="input-xlarge" name="gender_id" id="gender_id" >

<option value="">--Gender--</option>

<?php

while($row = $database->fetch_array($result_gender))

{

if($row['gender_id'] == $user->gender_id)

{

echo '<option selected="selected" value="'. $row['gender_id'] .'">'.$row['gender_name'].'</option>';

}

else

{

echo '<option value="'. $row['gender_id'] .'">'.$row['gender_name'].'</option>';

}

}

?>

</select>

</div>

</div>

</div>

<div class="control-group">

<label class="control-label" for="inputEmail">Date of Birth</label>

<div class="controls">

<div class="input-prepend">

<span class="add-on"><i class="icon-certificate"></i></span>

<input type="text" class="input-xlarge datepicker" required id="date_of_birth" name="date_of_birth" value="" placeholder="Date of Birth" />

</div>

</div>

</div>

<div class="control-group">

<label class="control-label" for="inputEmail">Email</label>

<div class="controls">

<div class="input-prepend">

<span class="add-on"><i class="icon-envelope"></i></span>

<input type="text" class="input-xlarge" id="email" name="email" value="<?php if(isset($user->email)) echo $user->email; ?>" placeholder="Enter e-mail" required readonly="true" />

</div>

</div>

</div>

<div class="control-group">

<label class="control-label" for="inputEmail">Phone Number</label>

<div class="controls">

<div class="input-prepend">

<span class="add-on"><i class="iconic-iphone"></i></span>

<input type="text" class="input-xlarge" id="phone_number" name="phone_number" value="<?php if(isset($user->phone_number)) echo $user->phone_number; ?>" maxlength="14" placeholder="Enter phone number" required readonly="true" />

</div>

</div>

</div>

<!-- Address -->

<div class="control-group">

<label class="control-label" for="inputAdress">Contact Address</label>

<div class="controls">

<div class="input-prepend">

<span class="add-on"><i class="icon-home"></i></span>

<textarea rows="4" placeholder="Contact Address" class="input-xlarge" id="contact_address" name="contact_address"><?php echo $user->contact_address;?></textarea>

</div>

</div>

</div>

<!-- Gender -->

<?php

$sql_gender = "SELECT * FROM gender WHERE gender_visible=1";

$result_gender = $database->query($sql_gender);

?>

<div class="control-group">

<label class="control-label" for="inputGender">Mode of Entry</label>

<div class="controls">

<div class="input-prepend">

<span class="add-on"><i class="icon-chevron-down"></i></span>

<select class="input-xlarge" name="gender_id" id="gender_id" >

<option value="">--Mode of Entry--</option>

<?php

while($row = $database->fetch_array($result_gender))

{

if($row['gender_id'] == $user->gender_id)

{

echo '<option selected="selected" value="'. $row['gender_id'] .'">'.$row['gender_name'].'</option>';

}

else

{

echo '<option value="'. $row['gender_id'] .'">'.$row['gender_name'].'</option>';

}

}

?>

</select>

</div>

</div>

</div>

<div class="control-group">

<label class="control-label" for="inputEmail">Year of Graduation</label>

<div class="controls">

<div class="input-prepend">

<span class="add-on"><i class="icon-certificate"></i></span>

<input type="text" class="input-xlarge datepicker" required id="year_of_graduation" name="year_of_graduation" value="" placeholder="Year of Graduation" />

</div>

</div>

</div>

<div class="control-group">

<label class="control-label" for="inputEmail">Year of Entry</label>

<div class="controls">

<div class="input-prepend">

<span class="add-on"><i class="icon-certificate"></i></span>

<input type="text" class="input-xlarge datepicker" required id="year_of_entry" name="year_of_entry" value="" placeholder="Year of Entry" />

</div>

</div>

</div>

<!-- Address -->

<div class="control-group">

<label class="control-label" for="inputAdress">Recieving Address</label>

<div class="controls">

<div class="input-prepend">

<span class="add-on"><i class="icon-home"></i></span>

<textarea rows="4" placeholder="Recieving Address" class="input-xlarge" id="receiving_address" name="receiving_address"><?php echo $user->receiving_address;?></textarea>

</div>

</div>

</div>

<div class="control-group">

<div class="controls">

<label class="checkbox">

<input type="checkbox" id="applied" name="applied" value="1">Have you ever applied for transcript before.

</label>

</div>

</div>

<hr>

<div class="control-group">

<div class="controls">

<button type="submit" class="btn btn-primary" id="submit"><i class="iconic-pen"></i> Submit</button>

<button type="button" onClick="document.location.href='index.php';" class="btn"><i class="iconic-x"></i> Cancel</button>

</div>

</div>

<hr>

</form>