@extends('layouts.registrarapp')
@section('content')

<div class="container">
    <h1 class="my-4">Application for Graduation</h1>
    @if(session('success'))
    <div class="alert alert-success">
        {{ session('success') }}
    </div>
    @endif
    <form action="/submit-graduation-application" method="post">
        {{ csrf_field() }}
        <!-- Personal Information -->
        <h3>Personal Information</h3>
        <div class="row mb-3">
            <div class="col-md-3">
                <label for="name">Name:</label>
                <input type="text" id="name" name="name" class="form-control" required>
            </div>
            <div class="col-md-3">
                <label for="course_program">Course/Program:</label>
                <input type="text" id="course_program" name="course_program" class="form-control" required>
            </div>
            <div class="col-md-3">
                <label for="date_application">Date of Application:</label>
                <input type="date" id="date_application" name="date_application" class="form-control" required>
            </div>
            <div class="col-md-4">
                <label for="expected_grad_date">Expected Date of Graduation:</label>
                <input type="date" id="expected_grad_date" name="expected_grad_date" class="form-control" required>
            </div>
        </div>

        <!-- Documents Checklist -->
        <h3>Documents Checklist</h3>
        <div class="mb-3">
            <label><input type="checkbox" name="documents[]" value="Form 137 (High School Graduate)"> Form 137 (High School Graduate)</label><br>
            <label><input type="checkbox" name="documents[]" value="Good Moral Character Certificate"> Good Moral Character Certificate</label><br>
            <label><input type="checkbox" name="documents[]" value="Recommendation Letter"> Recommendation Letter</label><br>
            <label><input type="checkbox" name="documents[]" value="Transfer Credential / Honorable Dismissal"> Transfer Credential / Honorable Dismissal</label><br>
            <label><input type="checkbox" name="documents[]" value="Official Transcript of Records"> Official Transcript of Records</label><br>
            <label><input type="checkbox" name="documents[]" value="NSO Birth Certificate"> NSO Birth Certificate</label><br>
            <label><input type="checkbox" name="documents[]" value="Marriage Certificate (NSO) for married female only"> Marriage Certificate (NSO) for married female only</label><br>
            <label><input type="checkbox" name="documents[]" value="1 pc. 2x2 ID Picture in Formal Attire/White Background"> 1 pc. 2x2 ID Picture in Formal Attire/White Background</label>
        </div>

        <h4>Academic Deficiencies</h4>
        <div class="mb-3">
            <label><input type="checkbox" name="deficiencies[]" value="Completion Grade/s"> Completion Grade/s</label><br>
            <label><input type="checkbox" name="deficiencies[]" value="Cross-Enrollment Grade"> Cross-Enrollment Grade</label><br>
            <label><input type="checkbox" name="deficiencies[]" value="P.E."> P.E.</label><br>
            <label><input type="checkbox" name="deficiencies[]" value="NSTP"> NSTP</label><br>
            <label><input type="checkbox" name="deficiencies[]" value="Course/Subject Description"> Course/Subject Description</label><br>
        </div>

        <div class="row mb-3">
            <div class="col-md-10">
                <label for="other_deficiencies">Others:</label>
                <textarea id="other_deficiencies" name="other_deficiencies" rows="3" class="form-control"></textarea>
            </div>
        </div>

        <!-- Candidate for Graduation -->
        <h3>Candidate for Graduation</h3>
        <div class="row mb-3">
            <div class="col-md-3">
                <label for="dob">Date of Birth:</label>
                <input type="date" id="dob" name="dob" class="form-control" required>
            </div>
            <div class="col-md-3">
                <label for="birthplace">Birthplace:</label>
                <input type="text" id="birthplace" name="birthplace" class="form-control" required>
            </div>
            <div class="col-md-3">
                <label for="major">Major:</label>
                <input type="text" id="major" name="major" class="form-control">
            </div>
            <div class="col-md-4">
                <label for="address">Permanent Address:</label>
                <input type="text" id="address" name="address" class="form-control" required>
            </div>
        </div>

        <div class="row mb-3">
            <div class="col-md-3">
                <label for="minor">Minor:</label>
                <input type="text" id="minor" name="minor" class="form-control">
            </div>
            <div class="col-md-3">
                <label for="tel_no">Tel. No.:</label>
                <input type="text" id="tel_no" name="tel_no" class="form-control">
            </div>
            <div class="col-md-3">
                <label for="mobile_no">Mobile No.:</label>
                <input type="text" id="mobile_no" name="mobile_no" class="form-control">
            </div>
            <div class="col-md-4">
                <label for="email">Email Address:</label>
                <input type="email" id="email" name="email" class="form-control" required>
            </div>
        </div>

        <!-- Preliminary Education -->
        <h4>Preliminary Education</h4>
        <div class="row mb-3">
            <div class="col-md-3">
                <label for="primary_school">Primary School:</label>
                <input type="text" id="primary_school" name="primary_school" class="form-control">
            </div>
            <div class="col-md-3">
                <label for="intermediate_school">Intermediate School:</label>
                <input type="text" id="intermediate_school" name="intermediate_school" class="form-control">
            </div>
            <div class="col-md-3">
                <label for="secondary_school">Secondary School:</label>
                <input type="text" id="secondary_school" name="secondary_school" class="form-control">
            </div>
        </div>

        <!-- Parent/Guardian Information -->
        <h4>Parent/Guardian Information</h4>
        <div class="row mb-3">
            <div class="col-md-3">
                <label for="parent_name">Name of Parent/Guardian:</label>
                <input type="text" id="parent_name" name="parent_name" class="form-control">
            </div>
            <div class="col-md-3">
                <label for="occupation">Occupation:</label>
                <input type="text" id="occupation" name="occupation" class="form-control">
            </div>
            <div class="col-md-3">
                <label for="parent_address">Address:</label>
                <input type="text" id="parent_address" name="parent_address" class="form-control">
            </div>
            <div class="col-md-4">
                <label for="contact_no">Contact No.:</label>
                <input type="text" id="contact_no" name="contact_no" class="form-control">
            </div>
        </div>

        <!-- Application for Graduation Reply Slip -->
        <h3>Application for Graduation Reply Slip</h3>
        <div class="row mb-3">
            <div class="col-md-5">
                <label for="reply_name">Name:</label>
                <input type="text" id="reply_name" name="reply_name" class="form-control">
            </div>
            <div class="col-md-5">
                <label for="reply_course">Course/Program:</label>
                <input type="text" id="reply_course" name="reply_course" class="form-control">
            </div>
            <div class="col-md-3">
                <label for="compliance">Date of Compliance:</label>
                <input type="date" id="compliance" name="compliance" class="form-control">
            </div>
        </div>

        <h4>Deficiencies</h4>
        <div class="mb-3">
            <label><input type="checkbox" name="reply_deficiencies[]" value="Form 137 (High School Graduate)"> Form 137 (High School Graduate)</label><br>
            <label><input type="checkbox" name="reply_deficiencies[]" value="Good Moral Character Certificate"> Good Moral Character Certificate</label><br>
            <label><input type="checkbox" name="reply_deficiencies[]" value="Recommendation Letter"> Recommendation Letter</label><br>
            <label><input type="checkbox" name="reply_deficiencies[]" value="Transfer Credential / Honorable Dismissal"> Transfer Credential / Honorable Dismissal</label><br>
            <label><input type="checkbox" name="reply_deficiencies[]" value="Official Transcript of Records"> Official Transcript of Records</label><br>
            <label><input type="checkbox" name="reply_deficiencies[]" value="NSO Birth Certificate"> NSO Birth Certificate</label><br>
            <label><input type="checkbox" name="reply_deficiencies[]" value="Marriage Certificate (NSO) for married female only"> Marriage Certificate (NSO) for married female only</label><br>
            <label><input type="checkbox" name="reply_deficiencies[]" value="1 pc. 2x2 ID Picture in Formal Attire/White Background"> 1 pc. 2x2 ID Picture in Formal Attire/White Background</label>
        </div>

        <div class="mb-3">
            <div class="col-md-3">
            <label for="reply_date">Date:</label>
            <input type="date" id="reply_date" name="reply_date" class="form-control">
            <div style="padding-top: 12px;">
                <button type="submit" class="btn btn-primary">Submit</button>
            </div>
            </div>
        </div>
        
         
    </form>
</div>

@endsection