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File: 2.php
<div class="panel"> <div class="panel-heading" style="background: #275555ff; color: honeydew;"> <h2 align="center" style="margin-top: 10px;">FORM ISIAN<br><b>IDENTITAS DIRI CALON MAHASISWA</b> </h2> <!-- <hr> --> </div> <div class="panel-body"> <div class="form-group" style="padding-bottom:30px;"> <label class="col-sm-3 control-label" style="text-align:right; margin-top:6px">Nomor Pendaftaran <span class="text-danger">*</span></label> <div class="col-sm-9 prepend-icon" style="margin-top:1px;"> <input type="text" name="nis" class="form-control bg-blue class" onkeypress="return hanyaAngka(this);" maxlength="30" placeholder="Nomor Induk Siswa" data-parsley-group="block1" data-parsley-errors-container='div[id="error-nis"]' value="<?= $id_daftar; ?>" readonly required> <i class="fa fa-users" style="margin-left:15px;"></i> <div id="error-nis" style=" background:#FFBABA; color: #D8000C; width:auto; padding-left:10px; font-size: 10px;"></div> <div id="pesan_komentar">*Jangan mengganti isian ini.</div> </div> </div> <div class="form-group" style="padding-bottom:30px;"> <label class="col-sm-3 control-label" style="text-align:right; margin-top:6px">Nama Lengkap <span class="text-danger">*</span></label> <div class="col-sm-9 prepend-icon"> <input type="text" name="nama_lengkap" class="form-control bg-blue" placeholder="Nama lengkap Calon Siswa" maxlength="100" data-parsley-group="block1" data-radio="iradio_square-blue" data-parsley-errors-container='div[id="error-nama_lengkap"]' required> <i class="fa fa-user" style="margin-left:15px;"></i> <div id="error-nama_lengkap" style=" background:#FFBABA; color: #D8000C; width:auto; padding-left:10px; font-size: 10px;"></div> <div id="pesan_komentar">*Sesuai dengan akte kelahiran/ijazah</div> </div> </div> <div class="form-group"> <label class="col-sm-3 control-label" style="text-align:right; margin-top:-3px">Jenis Kelamin <span class="text-danger">*</span></label> <div class="col-sm-9"> <div class="radio" style="margin-top:3px;margin-left:-20px;"> <label> <input type="radio" value="Laki-Laki" name="jk" data-parsley-group="block1" data-radio="iradio_square-blue" data-parsley-errors-container='div[id="condition-error"]' required> <i class="fa fa-male"></i> Laki-laki </label> </div> <div class="radio" style="margin-left:-20px;"> <label> <input type="radio" value="Perempuan" name="jk" data-parsley-group="block1" data-radio="iradio_square-blue" data-parsley-errors-container='div[id="condition-error"]' required> <i class="fa fa-female"></i> Perempuan </label> </div> <div id="condition-error" style=" background:#FFBABA; color: #D8000C; width:auto; padding-left:10px; font-size: 10px;"></div> </div> </div> <div class="form-group"> <label class="col-sm-3 control-label" style="text-align:right; margin-top:6px">Tempat Kelahiran <span class="text-danger">*</span></label> <div class="col-sm-9 prepend-icon"> <input type="text" name="tempat_lahir" class="form-control bg-blue class" placeholder="Tempat Kelahiran Calon Siswa" data-parsley-group="block1" data-parsley-errors-container='div[id="error-tempat_lahir"]' required> <i class="fa fa-building" style="margin-left:15px;"></i> <div id="error-tempat_lahir" style=" background:#FFBABA; color: #D8000C; width:auto; padding-left:10px; font-size: 10px;"></div> </div> </div> <div class="form-group"> <label class="col-sm-3 control-label" style="text-align:right; margin-top:6px">Tanggal Kelahiran <span class="text-danger">*</span></label> <div class="col-sm-9" style="margin-top:3px;"> <div class="col-sm-4" style="padding:0px"> <select class="form-control bg-blue class" name="tgl_lahir" data-parsley-group="block1" data-parsley-errors-container='div[id="error-tgl_lahir"]' required> <option value="" selected>Pilih Tanggal</option> <?php for ($i = 1; $i <= 31; $i++) { if ($i < 10) { $i = "0" . $i; } ?> <option value="<?php echo $i; ?>"><?php echo $i; ?></option> <?php } ?> </select> <div id="error-tgl_lahir" style=" background:#FFBABA; color: #D8000C; width:auto; padding-left:10px; font-size: 10px;"></div> </div> <div class="col-sm-4" style="padding-left:3px;"> <select class="form-control bg-blue class" data-placeholder="Pilih Bulan" name="bln_lahir" data-parsley-group="block1" data-parsley-errors-container='div[id="error-bln_lahir"]' required> <option value="" selected>Pilih Bulan</option> <option value="01">Januari</option> <option value="02">Februari</option> <option value="03">Maret</option> <option value="04">April</option> <option value="05">Mei</option> <option value="06">Juni</option> <option value="07">Juli</option> <option value="08">Agustus</option> <option value="09">September</option> <option value="10">Oktober</option> <option value="11">November</option> <option value="12">Desember</option> </select> <div id="error-bln_lahir" style=" background:#FFBABA; color: #D8000C; width:auto; padding-left:10px; font-size: 10px;"></div> </div> <div class="col-sm-4" style="margin-left:-27px;"> <select class="form-control bg-blue class" data-placeholder="Pilih Tahun Lahir" name="thn_lahir" data-parsley-group="block1" data-parsley-errors-container='div[id="error-thn_lahir"]' required> <option value="" selected>Pilih Tahun Lahir</option> <?php $thn_max = date('Y') - 2; for ($i = 1940; $i <= $thn_max; $i++) { ?> <option value="<?php echo $i; ?>"><?php echo $i; ?></option> <?php } ?> </select> <div id="error-thn_lahir" style=" background:#FFBABA; color: #D8000C; width:auto; padding-left:10px; font-size: 10px;"></div> </div> </div> </div> <div class="form-group"> <label class="col-sm-3 control-label" style="text-align:right; margin-top:6px">Agama <span class="text-danger">*</span></label> <div class="col-sm-9" style="margin-top:3px;"> <select class="form-control bg-blue class" data-placeholder="Pilih Agama yang dianut" name="agama" data-parsley-group="block1" data-parsley-errors-container='div[id="error-agama"]' required> <option value="">Pilih agama yang dianut</option> <option value="Islam">Islam</option> <option value="Kristen">Kristen</option> <option value="Katolik">Katolik</option> <option value="Hindu">Hindu</option> <option value="Budha">Budha</option> <option value="Konghucu">Konghucu</option> <option value="lainnya">Lainnya</option> </select> <div id="error-agama" style=" background:#FFBABA; color: #D8000C; width:auto; padding-left:10px; font-size: 10px;"></div> </div> </div> <div class="form-group"> <label class="col-sm-3 control-label" style="text-align:right; margin-top:6px">No. Handphone/WA <span class="text-danger">*</span></label> <div class="col-sm-9 prepend-icon" style="margin-top:3px;"> <input type="text" name="no_hp_siswa" class="form-control bg-blue class" maxlength="14" onkeypress="return hanyaAngka(this);" placeholder="No. Handphone Calon Siswa" data-parsley-group="block1" data-parsley-errors-container='div[id="error-no_hp_siswa"]' required> <i class="fa fa-phone" style="margin-left:15px;"></i> <div id="error-no_hp_siswa" style=" background:#FFBABA; color: #D8000C; width:auto; padding-left:10px; font-size: 10px;"></div> </div> </div> </div> </div> <div class="col-md-12"> <div>