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personal_details.php
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personal_details.php
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<?php
include'all.php';
?>
<script type="text/javascript">
var head = document.getElementsByTagName('head')[0],
link1 = document.createElement('link'),
link2 = document.createElement('link');
link1.href='assets/bootstrap/css/form-elements.css';
link1.rel='stylesheet';
link2.href='assets/bootstrap/css/style.css';
link2.rel='stylesheet';
head.appendChild(link1);
head.appendChild(link2);
</script>
<style>
.bg-title{
background: rgba(60,141,188,1);
background: -moz-linear-gradient(left, rgba(60,141,188,1) 0%, rgba(60,141,188,1) 0%, rgba(60,141,188,1) 59%, rgba(80,161,208,1) 97%, rgba(80,161,208,1) 100%);
background: -webkit-gradient(left top, right top, color-stop(0%, rgba(60,141,188,1)), color-stop(0%, rgba(60,141,188,1)), color-stop(59%, rgba(60,141,188,1)), color-stop(97%, rgba(80,161,208,1)), color-stop(100%, rgba(80,161,208,1)));
background: -webkit-linear-gradient(left, rgba(60,141,188,1) 0%, rgba(60,141,188,1) 0%, rgba(60,141,188,1) 59%, rgba(80,161,208,1) 97%, rgba(80,161,208,1) 100%);
background: -o-linear-gradient(left, rgba(60,141,188,1) 0%, rgba(60,141,188,1) 0%, rgba(60,141,188,1) 59%, rgba(80,161,208,1) 97%, rgba(80,161,208,1) 100%);
background: -ms-linear-gradient(left, rgba(60,141,188,1) 0%, rgba(60,141,188,1) 0%, rgba(60,141,188,1) 59%, rgba(80,161,208,1) 97%, rgba(80,161,208,1) 100%);
background: linear-gradient(to right, rgba(60,141,188,1) 0%, rgba(60,141,188,1) 0%, rgba(60,141,188,1) 59%, rgba(80,161,208,1) 97%, rgba(80,161,208,1) 100%);
filter: progid:DXImageTransform.Microsoft.gradient( startColorstr='#dd4b39', endColorstr='#f16f5c', GradientType=1 );
}
.bg-title2{
background: rgba(60,141,188,1);
background: -moz-linear-gradient(left, rgba(60,141,188,1) 0%, rgba(60,141,188,1) 0%, rgba(60,141,188,1) 27%, rgba(80,161,208,1) 90%, rgba(80,161,208,1) 100%);
background: -webkit-gradient(left top, right top, color-stop(0%, rgba(60,141,188,1)), color-stop(0%, rgba(60,141,188,1)), color-stop(27%, rgba(60,141,188,1)), color-stop(90%, rgba(80,161,208,1)), color-stop(100%, rgba(80,161,208,1)));
background: -webkit-linear-gradient(left, rgba(60,141,188,1) 0%, rgba(60,141,188,1) 0%, rgba(60,141,188,1) 27%, rgba(80,161,208,1) 90%, rgba(80,161,208,1) 100%);
background: -o-linear-gradient(left, rgba(60,141,188,1) 0%, rgba(60,141,188,1) 0%, rgba(60,141,188,1) 27%, rgba(80,161,208,1) 90%, rgba(80,161,208,1) 100%);
background: -ms-linear-gradient(left, rgba(60,141,188,1) 0%, rgba(60,141,188,1) 0%, rgba(60,141,188,1) 27%, rgba(80,161,208,1) 90%, rgba(80,161,208,1) 100%);
}
@media only screen and (max-width: 990px) {
.pm, .pro-box{
border-bottom:solid 1px silver;
padding-bottom: 10px;
}
.boxzol{
margin-bottom:20px;
}
.forum{
margin-left:5px;
margin-right:5px;
}
.forum2{
margin-left:5px;
margin-right:5px;
}
.topinfo{
margin-left:2px;
margin-right:2px;
}
}
@media only screen and (min-width: 990px) {
.pm{
border-right:solid 1px silver;
border-left:solid 1px silver;
}
.boxzol{
margin-bottom:10px;
}
.topinfo{
margin-left:10px;
margin-right:10px;
}
.forum2{
padding-left: 0px;
}
}
</style>
<div class="content-wrapper" style="background-image:url('images/backgrounds/1.jpg');padding-bottom:2%;background-repeat: no-repeat;background-size: cover;" >
<!-- /.box-header -->
<div class="row" style="min-height: 669px;background-image:url('images/backgrounds/1.jpg');background-repeat: no-repeat;background-size: cover;">
<!---ADD your Code here-->
<div class="col-sm-offset-3 col-sm-5">
<div class="form-box" align="center">
<div class="form-top">
<div class="form-top-left">
<h3>Personal Details</h3>
<p>Enter your details to apply for scholarship</p>
</div>
<div class="form-top-right">
<i class="fa fa-user"></i>
</div>
</div>
<div class="form-bottom" style="margin-bottom:10%">
<form role="form" action="login_reg_scripts/apply1.php" method="post" class="login-form">
<div class="form-group">
<label for="form-username">Name</label>
<input type="text" name="name" value="<?php echo $firstname." ".$surname;?>" placeholder="Name" class="form-username form-control" id="form-name" disabled>
</div>
<div class="form-group">
<label for="form-username">Aadhar Card No</label>
<input type="text" name="aadhar" value="<?php echo $firstname." ".$surname;?>" placeholder="Aadhar Card No" class="form-username form-control" id="form-aadhar" disabled>
</div>
<div class="form-group">
<label for="form-username">Email</label>
<input type="text" name="email" value="<?php echo $email;?>" placeholder="Email" class="form-username form-control" id="form-email" disabled>
</div>
<div class="form-group">
<label for="form-username">Mother's Name</label>
<input type="text" name="mothername" placeholder="Mother's Name" class="form-username form-control" id="form-mothername" >
</div>
<div class="form-group">
<label for="form-username">Father's Name</label>
<input type="text" name="fathername" placeholder="Father's Name" class="form-username form-control" id="form-fathername">
</div>
<div class="form-group">
<label for="form-username">Father's/Mother's Email</label>
<input type="text" name="email2" placeholder="Father's/Mother's Email" class="form-password form-control" id="form-email2" >
</div>
<div class="form-group">
<label for="form-username">DOB</label>
<input type="text" name="dob" value="<?php echo $dob;?>" placeholder="DOB" class="form-username form-control" id="form-dob" disabled>
</div>
<div class="form-group">
<label for="form-username">Contact</label>
<input type="text" name="contact" placeholder="Contact" class="form-username form-control" id="form-contact">
</div>
<div class="form-group">
<label for="form-username">Loan Amount</label>
<input type="text" name="loan" placeholder="Loan Amount" class="form-username form-control" id="form-loan">
</div>
<button type="submit" class="btn">Submit</button>
</form>
</div>
</div>
</div>
</div>
<!-- /.row -->
<!-- ./box-body -->
<!-- /.box-footer -->
<!-- /.box -->
<!-- /.col -->
<!-- /.row -->
</div>
<?php
include'footer.php';
?>