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DIR:/home/htlwork.com/www/edusort/resources/views/frontend/user/
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Current File : /home/htlwork.com/www/edusort/resources/views/frontend/user/form.blade.php
<!DOCTYPE html>
<html lang="en">
<head>
    <meta charset="UTF-8">
    <meta name="viewport" content="width=device-width, initial-scale=1.0">
    <title>Personal Details Form</title>
    <style>
        /* Add your CSS styles here */
        body {
            font-family:sans-serif;
            background-color: #f4f4f4;
            margin: 0;
            padding: 0;
        }
        .container {
            max-width: 800px;
            margin: auto;
            padding: 20px;
        }
        .card {
            background-color: #fff;
            padding: 20px;
            border-radius: 10px;
            box-shadow: 0 4px 8px rgba(0,0,0,0.1);
        }
        .form-group {
            margin-bottom: 20px;
        }
        label {
            display: block;
            margin-bottom: 5px;
        }
        input[type="text"],
        input[type="email"],
        input[type="tel"],
        input[type="number"],
        input[type="date"],
        select {
            width: 95%;
            padding: 10px;
            border: 1px solid #ccc;
            border-radius: 5px;
            transition: border-color 0.3s;
        }
        input[type="text"]:focus,
        input[type="email"]:focus,
        input[type="tel"]:focus,
        input[type="number"]:focus,
        input[type="date"]:focus,
        select:focus {
            border-color: #007bff;
            outline: none;
        }
        .error-message {
            color: red;
            font-size: 12px;
        }
        button[type="submit"] {
            background-color: #007bff;
            color: #fff;
            padding: 10px 20px;
            border: none;
            border-radius: 5px;
            cursor: pointer;
            transition: background-color 0.3s;
        }
        button[type="submit"]:hover {
            background-color: #3f90e7;
        }
    </style>
</head>
<body>

    <div class="container">
        <div class="card">
            <h2>Personal Details Form</h2>
           
            <!-- Your form content goes here -->
@if($message = Session::get('success'))
<div class="alert alert-success alert-block">
    <strong>{{ $message }}</strong>
</div>
@endif

	<form method="post" action="{{ url('/form') }}">
        @csrf
        {{-- <div>
        <label>Title:</label>
        <input type="checkbox" name="title" value="Mr"> Mr
        <input type="checkbox" name="title" value="Mrs"> Mrs
        <input type="checkbox" name="title" value="Miss"> Miss
        <input type="checkbox" name="title" value="Ms"> Ms
        <input type="checkbox" name="title" value="Dr"> Dr

        @error('title')
        <div class="error-message">{{ $message }}</div>
       @enderror
    </div> --}}
        <br><br>
   <div>
        <label>Family Name:</label>
        <input type="text" name="family_name" value="{{ old('family_name') }}">
        @error('family_name')
        <div class="error-message">{{ $message }}</div>
      @enderror
    </div>

        <br><br>

    <div>
        <label>Given Names:</label>
        <input type="text" name="given_names" value="{{ old('given_names') }}">
        @error('given_names')
        <div class="error-message">{{ $message }}</div>
      @enderror
    </div>
        <br><br>
       
        <div>
        <label>Former Family Name:</label>
        <input type="text" name="former_family_name" value="{{ old('former_family_name') }}">
        @error('former_family_name')
        <div class="error-message">{{ $message }}</div>
        @enderror
        </div>
        <br>

        
    <div>
        <label>Preferred Name:</label>
        <input type="text" name="preferred_name" value="{{ old('preferred_name') }}">
        @error('preferred_name')
        <div class="error-message">{{ $message }}</div>
        @enderror
    </div>
        <br><br>

        <div>
        <label>Date of Birth:</label>
        <input type="date" name="date_of_birth">
        @error('date_of_birth')
        <div class="error-message">{{ $message }}</div>
        @enderror
        </div>
        <br>
<div>
        <label>Passport Number:</label>
        <input type="text" name="passport_number" value="{{ old('passport_number') }}">
        @error('passport_number')
        <div class="error-message">{{ $message }}</div>
        @enderror
    </div>
        <br><br>

        <div>
        <label>Country of Birth:</label>

        <select name="country_of_birth" id="country">
            <option value="">Select a country</option>
            <option value="AF">Afghanistan</option>
            <option value="AL">Albania</option>
            <option value="DZ">Algeria</option>
            <option value="AS">American Samoa</option>
            <option value="AD">Andorra</option>
            <option value="AO">Angola</option>
            <option value="AI">Anguilla</option>
            <option value="AQ">Antarctica</option>
            <option value="AG">Antigua and Barbuda</option>
            <option value="AR">Argentina</option>
            <option value="AM">Armenia</option>
            <option value="AW">Aruba</option>
            <option value="AU">Australia</option>
            <option value="AT">Austria</option>
            <option value="AZ">Azerbaijan</option>
            <option value="BS">Bahamas</option>
            <option value="BH">Bahrain</option>
            <option value="BD">Bangladesh</option>
            <option value="BB">Barbados</option>
            <option value="BY">Belarus</option>
            <option value="BE">Belgium</option>
            <option value="BZ">Belize</option>
            <option value="BJ">Benin</option>
            <option value="BM">Bermuda</option>
            <option value="BT">Bhutan</option>
            <option value="BO">Bolivia</option>
            <option value="BA">Bosnia and Herzegovina</option>
            <option value="BW">Botswana</option>
            <option value="BV">Bouvet Island</option>
            <option value="BR">Brazil</option>
            <option value="IO">British Indian Ocean Territory</option>
            <option value="BN">Brunei Darussalam</option>
            <option value="BG">Bulgaria</option>
            <option value="BF">Burkina Faso</option>
            <option value="BI">Burundi</option>
            <option value="KH">Cambodia</option>
            <option value="CM">Cameroon</option>
            <option value="CA">Canada</option>
            <option value="CV">Cape Verde</option>
            <option value="KY">Cayman Islands</option>
            <option value="CF">Central African Republic</option>
            <option value="TD">Chad</option>
            <option value="CL">Chile</option>
            <option value="CN">China</option>
            <option value="CX">Christmas Island</option>
            <option value="CC">Cocos (Keeling) Islands</option>
            <option value="CO">Colombia</option>
            <option value="KM">Comoros</option>
            <option value="CG">Congo</option>
            <option value="CD">Congo, The Democratic Republic of The</option>
            <option value="CK">Cook Islands</option>
            <option value="CR">Costa Rica</option>
            <option value="CI">Cote D'ivoire</option>
            <option value="HR">Croatia</option>
            <option value="CU">Cuba</option>
            <option value="CY">Cyprus</option>
            <option value="CZ">Czech Republic</option>
            <option value="DK">Denmark</option>
            <option value="DJ">Djibouti</option>
            <option value="DM">Dominica</option>
            <option value="DO">Dominican Republic</option>
            <option value="EC">Ecuador</option>
            <option value="EG">Egypt</option>
            <option value="SV">El Salvador</option>
            <option value="GQ">Equatorial Guinea</option>
            <option value="ER">Eritrea</option>
            <option value="EE">Estonia</option>
            <option value="ET">Ethiopia</option>
            <option value="FK">Falkland Islands (Malvinas)</option>
            <option value="FO">Faroe Islands</option>
            <option value="FJ">Fiji</option>
            <option value="FI">Finland</option>
            <option value="FR">France</option>
            <option value="GF">French Guiana</option>
            <option value="PF">French Polynesia</option>
            <option value="TF">French Southern Territories</option>
            <option value="GA">Gabon</option>
            <option value="GM">Gambia</option>
            <option value="GE">Georgia</option>
            <option value="DE">Germany</option>
            <option value="GH">Ghana</option>
            <option value="GI">Gibraltar</option>
            <option value="GR">Greece</option>
            <option value="GL">Greenland</option>
            <option value="GD">Grenada</option>
            <option value="GP">Guadeloupe</option>
            <option value="GU">Guam</option>
            <option value="GT">Guatemala</option>
            <option value="GG">Guernsey</option>
            <option value="GN">Guinea</option>
            <option value="GW">Guinea-bissau</option>
            <option value="GY">Guyana</option>
            <option value="HT">Haiti</option>
            <option value="HM">Heard Island and Mcdonald Islands</option>
            <option value="VA">Holy See (Vatican City State)</option>
            <option value="HN">Honduras</option>
            <option value="HK">Hong Kong</option>
            <option value="HU">Hungary</option>
            <option value="IS">Iceland</option>
            <option value="IN">India</option>
            <option value="ID">Indonesia</option>
            <option value="IR">Iran, Islamic Republic of</option>
            <option value="IQ">Iraq</option>
            <option value="IE">Ireland</option>
            <option value="IM">Isle of Man</option>
            <option value="IL">Israel</option>
            <option value="IT">Italy</option>
            <option value="JM">Jamaica</option>
            <option value="JP">Japan</option>
            <option value="JE">Jersey</option>
            <option value="JO">Jordan</option>
            <option value="KZ">Kazakhstan</option>
            <option value="KE">Kenya</option>
            <option value="KI">Kiribati</option>
            <option value="KP">Korea, Democratic People's Republic of</option>
            <option value="KR">Korea, Republic of</option>
            <option value="KW">Kuwait</option>
            <option value="KG">Kyrgyzstan</option>
            <option value="LA">Lao People's Democratic Republic</option>
            <option value="LV">Latvia</option>
            <option value="LB">Lebanon</option>
            <option value="LS">Lesotho</option>
            <option value="LR">Liberia</option>
            <option value="LY">Libyan Arab Jamahiriya</option>
            <option value="LI">Liechtenstein</option>
            <option value="LT">Lithuania</option>
            <option value="LU">Luxembourg</option>
            <option value="MO">Macao</option>
            <option value="MK">Macedonia, The Former Yugoslav Republic of</option>
            <option value="MG">Madagascar</option>
            <option value="MW">Malawi</option>
            <option value="MY">Malaysia</option>
            <option value="MV">Maldives</option>
            <option value="ML">Mali</option>
            <option value="MT">Malta</option>
            <option value="MH">Marshall Islands</option>
            <option value="MQ">Martinique</option>
            <option value="MR">Mauritania</option>
            <option value="MU">Mauritius</option>
            <option value="YT">Mayotte</option>
            <option value="MX">Mexico</option>
            <option value="FM">Micronesia, Federated States of</option>
            <option value="MD">Moldova, Republic of</option>
            <option value="MC">Monaco</option>
            <option value="MN">Mongolia</option>
            <option value="ME">Montenegro</option>
            <option value="MS">Montserrat</option>
            <option value="MA">Morocco</option>
            <option value="MZ">Mozambique</option>
            <option value="MM">Myanmar</option>
            <option value="NA">Namibia</option>
            <option value="NR">Nauru</option>
            <option value="NP">Nepal</option>
            <option value="NL">Netherlands</option>
            <option value="AN">Netherlands Antilles</option>
            <option value="NC">New Caledonia</option>
            <option value="NZ">New Zealand</option>
            <option value="NI">Nicaragua</option>
            <option value="NE">Niger</option>
            <option value="NG">Nigeria</option>
            <option value="NU">Niue</option>
            <option value="NF">Norfolk Island</option>
            <option value="MP">Northern Mariana Islands</option>
            <option value="NO">Norway</option>
            <option value="OM">Oman</option>
            <option value="PK">Pakistan</option>
            <option value="PW">Palau</option>
            <option value="PS">Palestinian Territory, Occupied</option>
            <option value="PA">Panama</option>
            <option value="PG">Papua New Guinea</option>
            <option value="PY">Paraguay</option>
            <option value="PE">Peru</option>
            <option value="PH">Philippines</option>
            <option value="PN">Pitcairn</option>
            <option value="PL">Poland</option>
            <option value="PT">Portugal</option>
            <option value="PR">Puerto Rico</option>
            <option value="QA">Qatar</option>
            <option value="RE">Reunion</option>
            <option value="RO">Romania</option>
            <option value="RU">Russian Federation</option>
            <option value="RW">Rwanda</option>
            <option value="SH">Saint Helena</option>
            <option value="KN">Saint Kitts and Nevis</option>
            <option value="LC">Saint Lucia</option>
            <option value="PM">Saint Pierre and Miquelon</option>
            <option value="VC">Saint Vincent and The Grenadines</option>
            <option value="WS">Samoa</option>
            <option value="SM">San Marino</option>
            <option value="ST">Sao Tome and Principe</option>
            <option value="SA">Saudi Arabia</option>
            <option value="SN">Senegal</option>
            <option value="RS">Serbia</option>
            <option value="SC">Seychelles</option>
            <option value="SL">Sierra Leone</option>
            <option value="SG">Singapore</option>
            <option value="SK">Slovakia</option>
            <option value="SI">Slovenia</option>
            <option value="SB">Solomon Islands</option>
            <option value="SO">Somalia</option>
            <option value="ZA">South Africa</option>
            <option value="GS">South Georgia and The South Sandwich Islands</option>
            <option value="ES">Spain</option>
            <option value="LK">Sri Lanka</option>
            <option value="SD">Sudan</option>
            <option value="SR">Suriname</option>
            <option value="SJ">Svalbard and Jan Mayen</option>
            <option value="SZ">Swaziland</option>
            <option value="SE">Sweden</option>
            <option value="CH">Switzerland</option>
            <option value="SY">Syrian Arab Republic</option>
            <option value="TW">Taiwan, Province of China</option>
            <option value="TJ">Tajikistan</option>
            <option value="TZ">Tanzania, United Republic of</option>
            <option value="TH">Thailand</option>
            <option value="TL">Timor-leste</option>
            <option value="TG">Togo</option>
            <option value="TK">Tokelau</option>
            <option value="TO">Tonga</option>
            <option value="TT">Trinidad and Tobago</option>
            <option value="TN">Tunisia</option>
            <option value="TR">Turkey</option>
            <option value="TM">Turkmenistan</option>
            <option value="TC">Turks and Caicos Islands</option>
            <option value="TV">Tuvalu</option>
            <option value="UG">Uganda</option>
            <option value="UA">Ukraine</option>
            <option value="AE">United Arab Emirates</option>
            <option value="GB">United Kingdom</option>

        </select>

        {{-- <input type="text" name="country_of_birth" value="{{ old('country_of_birth') }}"> --}}
        @error('country_of_birth')
        <div class="error-message">{{ $message }}</div>
        @enderror
        </div><br>
    <div>
        <label>Nationality:</label>
        <input type="text" name="nationality"  value="{{ old('nationality') }}">
        @error('nationality')
        <div class="error-message">{{ $message }}</div>
        @enderror
    
    </div>
        <br><br>
        <div>
        <label>Marital Status:</label>
        <input type="radio" name="marital_status" value="Single"> Single
        <input type="radio" name="marital_status" value="Married"> Married
        @error('marital_status')
        <div class="error-message">{{ $message }}</div>
        @enderror
      </div>

        <br><br>


        <div>
            <label>course applying for:</label>
            <input type="text" name="course_name" value="{{$courses->course_name}}" readonly> 
           
           
          </div>

        <div>

            <br><br>
            <label>Are you in Australia?</label>
            <input type="radio" name="in_australia" value="1"> Yes
            <input type="radio" name="in_australia" value="0"> No
            @error('in_australia')
                <div class="error-message">{{ $message }}</div>
            @enderror
        </div>

        <br><br>
        
        <h2>Home Address</h2>
        
        <label>Home Address:</label>
        <input type="text" name="home_address" value="{{ old('home_address') }}">
        @error('home_address')
        <div class="error-message">{{ $message }}</div>
        @enderror
        
       
        <label>Suburb / Town:</label>
        <input type="text" name="suburb_town" value="{{ old('suburb_town') }}">

        @error('suburb_town')
        <div class="error-message">{{ $message }}</div>
        @enderror
        <br><br>

        <label>State / Region:</label>
        <input type="text" name="state_region" value="{{ old('state_region') }}">
        @error('state_region')
        <div class="error-message">{{ $message }}</div>
        @enderror
        
        
        <label>Postcode / Zip:</label>
        <input type="text" name="postcode_zip" value="{{ old('postcode_zip') }}">
        @error('postcode_zip')
        <div class="error-message">{{ $message }}</div>
        @enderror
        
        <label>Country:</label>
        <input type="text" name="country" value="{{ old('country') }}">
        @error('country')
        <div class="error-message">{{ $message }}</div>
        @enderror

        <br><br>

        <h2>Postal Address</h2>

        <label>Postal Address:</label>
        <input type="text" name="postal_address" value="{{ old('postal_address') }}">
        @error('postal_address')
        <div class="error-message">{{ $message }}</div>
        @enderror
        
        <label>Suburb / Town:</label>
        <input type="text" name="postal_suburb_town" value="{{ old('postal_suburb_town') }}">
        @error('postal_suburb_town')
        <div class="error-message">{{ $message }}</div>
        @enderror

        <br><br>

        <label>State / Region:</label>
        <input type="text" name="postal_state_region" value="{{ old('postal_state_region') }}">
        @error('postal_state_region')
        <div class="error-message">{{ $message }}</div>
        @enderror
        
        <label>Postcode / Zip:</label>
        <input type="text" name="postal_postcode_zip" value="{{ old('postal_postcode_zip') }}">
        @error('postal_postcode_zip')
        <div class="error-message">{{ $message }}</div>
        @enderror
        
        <label>Country:</label>
        <input type="text" name="postal_country25" value="{{ old('postal_country25') }}">
        @error('postal_country25')
        <div class="error-message">{{ $message }}</div>
        @enderror

        <br><br>

        <h2>Contact Details</h2>
        <label>Email Address:</label>
        <input type="email" name="email_address" value="{{ old('email_address') }}">
        @error('email_address')
        <div class="error-message">{{ $message }}</div>
        @enderror
        
        <label>Telephone:</label>
        <input type="tel" name="telephone" value="{{ old('telephone') }}">
        @error('telephone')
        <div class="error-message">{{ $message }}</div>
        @enderror

        <br><br>

        
        <h2>Emergency Contact Details</h2>
        <label>Name:</label>
        <input type="text" name="emergency_contact_name" value="{{ old('emergency_contact_name') }}">
        @error('emergency_contact_name')
        <div class="error-message">{{ $message }}</div>
        @enderror

        <label>Telephone:</label>
        <input type="tel" name="emergency_contact_telephone" value="{{ old('emergency_contact_telephone') }}">
        @error('emergency_contact_telephone')
        <div class="error-message">{{ $message }}</div>
        @enderror

        <label>Email:</label>
        <input type="email" name="emergency_contact_email" value="{{ old('emergency_contact_email') }}">
        @error('emergency_contact_email')
        <div class="error-message">{{ $message }}</div>
        @enderror

        <br><br>

        <h2>Current Study</h2>
        <div>
            <label>Are you currently studying in Australia?</label>
            <input type="radio" name="currently_studying_australia" value="1"> Yes
            <input type="radio" name="currently_studying_australia" value="0"> No
            @error('currently_studying_australia')
                <div class="error-message">{{ $message }}</div>
            @enderror
        </div>
        

        <br><br>

        {{-- <h2>COURSE PREFERENCE</h2>
        <p> Which intake and location you would like to apply for?</p>
        <style>
            table, th, td {
                border: 1px solid black;
            }
            td {
                border: 1px solid black;
                text-align: center;
                padding: 20px;
                width:10%;
            }
            th {
                padding: 20px;
                width:10%;
            }
        </style>
        
        
        
        <table>
            <tr>
                <th rowspan="2"></th>
                <th colspan="3">2023</th>
                <th colspan="3">2024</th>
                <th>2025</th>
            </tr>
            <tr>
                <td>February</td>
                <td>July</td>
                <td>November</td>
                <td>February</td>
                <td>July</td>
                <td>November</td>
                <td>February</td>
            </tr>
            <tr>
                <td></td>
                <td><input type="text"></td>
                <td><input type="text"></td>
                <td><input type="text"></td>
                <td><input type="text"></td>
                <td><input type="text"></td>
                <td><input type="text"></td>
                <td><input type="text"></td>
            </tr>
            <tr>
                <td></td>
                <td><input type="text"></td>
                <td><input type="text"></td>
                <td><input type="text"></td>
                <td><input type="text"></td>
                <td><input type="text"></td>
                <td><input type="text"></td>
                <td><input type="text"></td>
            </tr>
            <tr>
                <td></td>
                <td><input type="text"></td>
                <td><input type="text"></td>
                <td><input type="text"></td>
                <td><input type="text"></td>
                <td><input type="text"></td>
                <td><input type="text"></td>
                <td><input type="text"></td>
            </tr>
        </table>
 
     <br><br> --}}
     {{-- <p>Which course you would like to apply for?</p>
     
     <label for="course1">Course 1:</label>
         <input type="text" id="course1" name="course1">
 
         <br><br>
 
         <label for="course2">Course 2:</label>
         <input type="text" id="course2" name="course2">
 
         <br><br>
 
         <label for="course3">Course 3:</label>
         <input type="text" id="course3" name="course3">
 
         <br><br>
 
        <div>
         <label>Are you applying to study externally by distance education?</label>
         <input type="radio" id="distance_education" name="distance_education" value="Yes"> Yes
         <input type="radio" id="distance_education" name="distance_education" value="No"> No
         @error('distance_education')
                <div class="error-message">{{ $message }}</div>
            @enderror
        </div>
         <br><br> --}}
 
         <div>
         <h2>English Language Proficiency</h2>
         <label>Have you applied to study an Academic English course?</label>
         <input type="radio" id="academic_english_course" name="academic_english_course" value="1"> Yes
         <input type="radio" id="academic_english_course" name="academic_english_course" value="0"> No
         @error('academic_english_course')
         <div class="error-message">{{ $message }}</div>
         @enderror
    </div>
         <br><br>
 
         <label>Which of the following English language proficiency tests have you taken, or do you plan to take?</label>
         <br>
         <div>
         <input type="radio" id="ielts" name="english_tests" value="IELTS"> IELTS
         <input type="radio" id="toefl" name="english_tests" value="TOEFL"> TOEFL
         <input type="radio" id="pte" name="english_tests" value="PTE"> PTE
         <input type="radio" id="other" name="english_tests" value="Other"> OTHER
         @error('english_tests')
         <div class="error-message">{{ $message }}</div>
         @enderror
        </div>
         <br><br>
         <div>
             <label for="overall_band_score">Overall Band Score:</label>
             <input type="number" id="overall_band_score" name="overall_band_score" min="0" max="9" step="0.5">
             @error('overall_band_score')
            <div class="error-message">{{ $message }}</div>
            @enderror
     
 
         
             <label for="listening">Listening:</label>
             <input type="number" id="listening" name="listening" min="0" max="9" step="0.5">
             @error('listening')
             <div class="error-message">{{ $message }}</div>
             @enderror
        
 
       
             <label for="reading">Reading:</label>
             <input type="number" id="reading" name="reading" min="0" max="9" step="0.5">
             @error('listening')
             <div class="error-message">{{ $message }}</div>
             @enderror
        
 
         
             <label for="writing">Writing:</label>
             <input type="number" id="writing" name="writing" min="0" max="9" step="0.5">
             @error('writing')
             <div class="error-message">{{ $message }}</div>
             @enderror
        
 
         
             <label for="speaking">Speaking:</label>
             <input type="number" id="speaking" name="speaking" min="0" max="9" step="0.5">
             @error('speaking')
             <div class="error-message">{{ $message }}</div>
             @enderror
         
     </div>
 
         <br><br>
        <div>
         <h2>Secondary Studies (Senior School)</h2>
         <label for="institution">Institution:</label>
         <input type="text" id="institution" name="institution" value="{{ old('institution') }}" >
         @error('institution')
         <div class="error-message">{{ $message }}</div>
         @enderror
        </div>
        <br><br>

        <div>
         <label for="qualification">Qualification:</label>
         <input type="text" id="qualification" name="qualification" value="{{ old('qualification') }}">
         @error('qualification')
         <div class="error-message">{{ $message }}</div>
         @enderror
        </div> 
        <br><br> 

        
         <label for="course_length">Course Length:</label>
         <input type="text" id="course_length" name="course_length" value="{{ old('course_length') }}">
         @error('course_length')
         <div class=error-message">{{ $message }}</div>
         @enderror
        

        
         <label for="year_completion">Year of Completion:</label>
         <input type="text" id="year_completion" name="year_completion" value="{{ old('year_completion') }}">
         @error('year_completion')
         <div class=error-message">{{ $message }}</div>
         @enderror
        

        
         <label for="country">Country:</label>
         <input type="text" id="country" name="country11" value="{{ old('country11') }}">
         @error('country11')
         <div class="error-message">{{ $message }}</div>
         @enderror
        
         <br><br>
 
         <h2>Post Secondary Studies </h2>
 
         <div>
         <label for="institution1">Institution1:</label>
         <input type="text" id="institution1" name="institution1" value="{{ old('course_length') }}">
         @error('institution1')
             <div class="error-message">{{ $message }}</div>
             @enderror
            </div>
         <br><br>
         

         <div>
         <label for="qualification1">Qualification:</label>
         <input type="text" id="qualification1" name="qualification1"  value="{{ old('qualification1') }}">
         @error('qualification1')
             <div class="error-message">{{ $message }}</div>
             @enderror
            </div>
         <br><br>

        
         <label for="course_length1">Course Length:</label>
         <input type="text" id="course_length1" name="course_length1"  value="{{ old('course_length1') }}">
         @error('course_length1')
             <div class="error-message">{{ $message }}</div>
             @enderror
        
 
        
         <label for="year_completion1">Year of Completion:</label>
         <input type="text" id="year_completion1" name="year_completion1"  value="{{ old('year_completion1') }}">
         @error('year_completion1')
             <div class="error-message">{{ $message }}</div>
             @enderror
        
 
        
         <label for="country1">Country:</label>
         <input type="text" id="country1" name="country1" value="{{ old('country1') }}" >
         @error('country1')
             <div class="error-message">{{ $message }}</div>
             @enderror
        
         <br><br>
 
         <div>
         <label for="institution2">Institution2:</label>
         <input type="text" id="institution2" name="institution2" value="{{ old('institution2') }}">
         @error('institution2')
         <div class="error-message">{{ $message }}</div>
         @enderror
        </div>
         <br><br>
 
         <label for="qualification2">Qualification:</label>
         <input type="text" id="qualification2" name="qualification2" value="{{ old('qualification2') }}">
         @error('qualification2')
         <div class="error-message">{{ $message }}</div>
         @enderror
         <br><br>
 
         <label for="course_length2">Course Length:</label>
         <input type="text" id="course_length2" name="course_length2" value="{{ old('course_length2') }}">
         @error('course_length2')
         <div class="error-message">{{ $message }}</div>
         @enderror
 
         <label for="year_completion2">Year of Completion:</label>
         <input type="text" id="year_completion2" name="year_completion2" value="{{ old('year_completion2') }}">
         @error('course_length2')
         <div class="error-message">{{ $message }}</div>
         @enderror
 
         <label for="country2">Country:</label>
         <input type="text" id="country2" name="country2" value="{{ old('country2') }}">
         @error('country2')
         <div class="error-message">{{ $message }}</div>
         @enderror
         <br><br>
 
         <label>Will you be applying for advanced standing (credit transfer)
              based on your previous study?</label><br>
        <div>
         <input type="radio" id="advanced_standing_yes" name="advanced_standing" value="Yes">Yes
         {{-- <label for="advanced_standing_yes">Yes</label> --}}
         <input type="radio" id="advanced_standing_no" name="advanced_standing" value="No">No
         {{-- <label for="advanced_standing_no">No</label> --}}
         @error('advanced_standing')
         <div class="error-message">{{ $message }}</div>
         @enderror
        </div>
         <br><br>
 

         <h2>Visa Information </h2>
         <div>
         <label for="australian_visa_rejected">Have you ever had an Australian visa application rejected?</label><br>
         <input type="radio" id="australian_visa_rejected_no" name="australian_visa_rejected" value="No">No
         <input type="radio" id="australian_visa_rejected_yes" name="australian_visa_rejected" value="Yes">Yes
         @error('australian_visa_rejected')
         <div class="error-message">{{ $message }}</div>
         @enderror
        </div>
        <br><br>
 
        <div>
         <label for="other_country_visa_rejected">Have you ever had a visa rejected for any other country?</label><br>
         <input type="radio" id="other_country_visa_rejected_no" name="other_country_visa_rejected" value="No">No
         {{-- <label for="other_country_visa_rejected_no">No</label><br> --}}
         <input type="radio" id="other_country_visa_rejected_yes" name="other_country_visa_rejected" value="Yes">Yes
         {{-- <label for="other_country_visa_rejected_yes">Yes</label> --}}
         @error('other_country_visa_rejected')
         <div class="error-message">{{ $message }}</div>
         @enderror
        </div>
         <br><br>
        
         <div>
         <label for="current_australian_visa">Do you have a current Australian visa?</label><br>
         <input type="radio" id="current_australian_visa_no" name="current_australian_visa" value="0">No
         {{-- <label for="current_australian_visa_no">No</label><br> --}}
         <input type="radio" id="current_australian_visa_yes" name="current_australian_visa" value="1">Yes
         {{-- <label for="current_australian_visa_yes">Yes</label> --}}
         @error('current_australian_visa')
         <div class="error-message">{{ $message }}</div>
         @enderror
        </div>
         <br><br>
 
         <div>
         <label for="visa_subclass">Visa subclass:</label><br>
         <input type="text" id="visa_subclass" name="visa_subclass" value="{{ old('visa_subclass') }}">
         @error('visa_subclass')
         <div class="error-message">{{ $message }}</div>
         @enderror
        </div>
         <br><br>

        <div>
         <label for="applying_student_visa">Will you be applying for a student visa to study in Australia?</label><br>
         <input type="radio" id="applying_student_visa_no" name="applying_student_visa" value="0">No
         {{-- <label for="applying_student_visa_no">No</label><br> --}}
         <input type="radio" id="applying_student_visa_yes" name="applying_student_visa" value="1">Yes
         {{-- <label for="applying_student_visa_yes">Yes</label> --}}
         @error('applying_student_visa')
         <div class="error-message">{{ $message }}</div>
         @enderror
        </div>
         <br><br>
 
         <h2>Overseas Student Health Cover (OSHC)</h2>
        <div>
         <label for="current_oshc">Do you currently have OSHC?</label><br>
         <input type="radio" id="current_oshc_no" name="current_oshc" value="0">No
         {{-- <label for="current_oshc_no">No</label> --}}
         <input type="radio" id="current_oshc_yes" name="current_oshc" value="1">Yes
         {{-- <label for="current_oshc_yes">Yes</label> --}}
         @error('applying_student_visa')
         <div class="error-message">{{ $message }}</div>
         @enderror
        </div>
         <br><br>
 
         <div>
         <label for="oshc_cover_type">Please indicate what type of OSHC cover you require:</label><br>
         <input type="radio" id="oshc_cover_type_single" name="oshc_cover_type" value="Single">Single
         {{-- <label for="oshc_cover_type_single">Single</label> --}}
         <input type="radio" id="oshc_cover_type_couple" name="oshc_cover_type" value="Couple">Couple
         {{-- <label for="oshc_cover_type_couple">Couple</label> --}}
         <input type="radio" id="oshc_cover_type_family" name="oshc_cover_type" value="Family">Family
         {{-- <label for="oshc_cover_type_family">Family</label> --}}
         @error('oshc_cover_type')
         <div class="error-message">{{ $message }}</div>
         @enderror
        </div>
         <br><br>
 
         <h2>Dependents Information </h2>
         <div>
         <label for="bring_spouse">Do you intend to bring your spouse with you to Australia?</label><br>
         <input type="radio" id="bring_spouse_no" name="bring_spouse" value="0">No
         {{-- <label for="bring_spouse_no">No</label><br> --}}
         <input type="radio" id="bring_spouse_yes" name="bring_spouse" value="1">Yes
         {{-- <label for="bring_spouse_yes">Yes</label> --}}
         @error('bring_spouse')
         <div class="error-message">{{ $message }}</div>
         @enderror
        </div>
        <br><br>

        <div>
         <label for="bring_children">Do you intend to bring your children with you to Australia?</label><br>
         <input type="radio" id="bring_children_no" name="bring_children" class="bring_children" value="0">No
         {{-- <label for="bring_children_no">No</label><br> --}}
         <input type="radio" id="bring_children_yes" class="bring_children" name="bring_children" value="1">Yes
         {{-- <label for="bring_children_yes">Yes</label><br> --}}
         @error('bring_children')
         <div class="error-message">{{ $message }}</div>
         @enderror
        </div>
<br>
        <div>
         <label for="number_of_children" style="display: none" class="how_many">How many?</label>
         <input type="number" id="number_of_children" name="number_of_children" class="how_many" min="0" style="display: none">
         @error('number_of_children')
         <div class="error-message">{{ $message }}</div>
         @enderror
        </div>
         <br><br>
 
         <h2>Disability Support</h2>
        <div>

         <label for="disability">Do you have a physical or sensory disability, learning disability, medical illness, or a psychological condition that may impact on your ability to access and participate in study?</label><br>
         <input type="radio" id="disability_no" name="disability" value="0">NO
         {{-- <label for="disability_no">No</label> --}}
         <input type="radio" id="disability_yes" name="disability" value="1">YES
         {{-- <label for="disability_yes">Yes</label> --}}
         @error('disability')
         <div class="error-message">{{ $message }}</div>
         @enderror
        </div>
         <br><br>
 
         <h2>Declaration </h2>
         <h3>DECLARATION BY THE APPLICANT:</h3>

         <div>
           
         <label for="applicant_declaration">  <input type="checkbox" id="applicant_declaration" name="applicant_declaration"value="1"> I declare that the information I have provided is true and correct and I have read and understood the conditions of application.</label><br>
        
         @error('applicant_declaration')
         <div class="error-message">{{ $message }}</div>
         @enderror
        </div>

         {{-- <br><br> --}}

        {{-- <div>
         <label for="applicant_signature">Student signature:</label>
         <input type="text" id="applicant_signature" name="applicant_signature">
         @error('applicant_signature')
         <div class="error-message">{{ $message }}</div>
         @enderror
        </div>

        <div>
         <label for="applicant_date">Date:</label>
         <input type="date" id="applicant_date" name="applicant_date">
         @error('applicant_date')
         <div class="error-message">{{ $message }}</div>
         @enderror
        </div> --}}
        {{-- <br><br>  --}}
        <button type="submit">Submit</button>
    </form>
        </div>
    </div>
    <script src="https://ajax.googleapis.com/ajax/libs/jquery/3.7.1/jquery.min.js"></script>
    <script>
    $(document).ready(function(){
      $(".bring_children").click(function(){
       var val=$(this).val();
       if(val == 1){
        $(".how_many").show();
       }else{
        $(".how_many").hide();
       }
      });
    });
    </script>
    <!-- JavaScript for handling error messages -->
    <script>
        // Add error message handling for each field
        document.addEventListener('DOMContentLoaded', function() {
            const form = document.querySelector('form');
            form.addEventListener('submit', function(event) {
                const inputs = form.querySelectorAll('input, select');
                inputs.forEach(function(input) {
                    const errorMessage = input.parentElement.querySelector('.error-message');
                    if (!input.checkValidity()) {
                        errorMessage.textContent = input.validationMessage;
                        input.classList.add('invalid');
                    } else {
                        errorMessage.textContent = '';
                        input.classList.remove('invalid');
                    }
                });
                event.preventDefault();
            });
        });
    </script>
</body>
</html>