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kemikazii on 12/10/15

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Course Registration Form


/ Published in: HTML
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A course registration form written in HTML


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  1. <title>Kemoy Joseph</title>
  2. <img src="kclg.jpg" height = "100">
  3. <link href="form.css" rel="stylesheet" type "text/css">
  4. <script type="text/javascript">
  5. prompt("What is your name?")
  6.  
  7. <h1 style ="text-align:center"><b><u>Course Selection</u></b></h1>
  8. <h5>* is a required field</h5>
  9.  
  10. <form id = "math"action="mailto:[email protected]" method="post" enctype="text/plain">
  11.  
  12. <input type="hidden" name="email" id="email"value="[email protected]" /><!--Inputs a hidden box for the email address-->
  13.  
  14. <fieldset id="name">
  15. <legend>Login</legend>
  16. <label class="login">
  17. Username<span>*</span>
  18. <input type="text" id="user" name="user" />
  19. Password<span>*</span>
  20. <input type="text" id="pass" name="pass" />
  21.  
  22.  
  23.  
  24.  
  25.  
  26. <br clear="all"><fieldset id="address">
  27. <legend>Name</legend>
  28. First Name<span>*</span>
  29. <input type="text" id="first" name="first" maxlength="15" />
  30.  
  31. <br>Last Name<span>*</span>
  32. <input type="text" id="last" name="last" maxlength="15" />
  33. </label></br>
  34.  
  35.  
  36.  
  37. <fieldset id="cont">
  38. <legend>Address</legend>
  39. Street<span>*</span>
  40. <input type="text" id="str" name="str" maxlength="20" />
  41.  
  42. <br>City<span>*</span>
  43. <input type="text" id="city" name="city" maxlength="10" />
  44.  
  45. <br>State<span>*</span>
  46. <input type="text" id="state" name="state" value = "NY" />
  47.  
  48. <br>ZIP<span>*</span>
  49. <input type="text" id="zip" name="zip" maxlength="10" />
  50. </label></br>
  51.  
  52.  
  53. <br clear="all"><fieldset id = "crs">
  54. <legend>High School Courses Taken<span>*</span></legend>
  55.  
  56. <b><u>Language</u></b>
  57. <select name="name" id="id">
  58. <option value="value1">Spanish</option>
  59. <option value="value2">French</option>
  60. <option value="value2">No Language</option>
  61. <br><br>
  62. <b><u>Field Related</u></b>
  63. <select multiple = "multiple">
  64.  
  65. <optgroup label="Business">
  66. <option>Accounts</option>
  67. <option>Office Administration</option>
  68. <option>Business Administration</option>
  69.  
  70. <optgroup label="Science">
  71. <option>Biology</option>
  72. <option>Chemistry</option>
  73. <option>Physics</option>
  74.  
  75. </select></br>
  76.  
  77. <br><b><u>Main Courses</u></b>
  78. <input type="checkbox" id="enga" name="enga" />
  79. English Language
  80. <input type="checkbox" id="engb" name="engb" />
  81. English Literature
  82.  
  83. <input type="checkbox" id="mat" name="mat" />
  84. Mathematics
  85. </label></br>
  86.  
  87.  
  88.  
  89.  
  90. <br><b><u>Electives</u></b></br>
  91. <label for="it">Information Technology</label>
  92. <input type="radio" name="sub" id="it" value="value1" />
  93.  
  94. <br><label for="art">Arts and Craft</label>
  95. <input type="radio" name="sub" id="art" value="value2" />
  96.  
  97.  
  98.  
  99. <br><label for="td">Technical Drawing</label>
  100. <input type="radio" name="sub" id="td" value="value3" />
  101.  
  102. <br><label for="art">None</label>
  103. <input type="radio" name="sub" id="none" value="value2" /></br>
  104.  
  105. <br>
  106. <label for="comments" class="blockLabel"><b><u>Other Courses Taken</b></u></label>
  107. <textarea id="comments" name="comments"rows="5" cols="50"></textarea>
  108.  
  109.  
  110.  
  111. <br clear="all"><fieldset>
  112. <legend>Major Selection<span>*</span></legend>
  113.  
  114. <label for="cis">Computer Information Systems</label>
  115. <input type="radio" name="sub" id="cis" value="value1" />
  116.  
  117. <br><label for="act">Accounting</label>
  118. <input type="radio" name="sub" id="act" value="value2" />
  119.  
  120. <br><label for="cs">Computer Science</label>
  121. <input type="radio" name="sub" id="cs" value="value2" />
  122.  
  123. <br><label for="cj">Criminal Justice</label>
  124. <input type="radio" name="sub" id="cj" value="value2" />
  125.  
  126. <br clear="all"><fieldset>
  127. <legend>Course Selection(Spring 2014)<span>*</span></legend>
  128. <input type="checkbox" id="cis22" name="cis22" />
  129. CIS2200
  130.  
  131. <br clear="all"><label>
  132. <input type="checkbox" id="cp11" name="cp11" />
  133. CP1100
  134.  
  135. <br clear="all"><label>
  136. <input type="checkbox" id="cp5" name="cp5" />
  137. CP500
  138.  
  139. <br clear="all"><label>
  140. <input type="checkbox" id="cis32" name="cis32" />
  141. CIS3200
  142.  
  143.  
  144. <br clear="all"><label for="comments" class="blockLabel"><b><u>Comments</b></u></label>
  145. <textarea id="comments" name="comments"rows="5" cols="50"></textarea>
  146.  
  147.  
  148. <br clear="all"><input type="submit" value="Submit" />
  149. <input type="reset" value="Reset" />
  150. <br clear="all">
  151. <br clear="all"><button name="home" id="home" value="home" type="button">
  152. <img src="hmic.jpg" height = "30" width = "30" background = "grey">
  153. Return to Home Page
  154. <br clear="all">
  155. <br clear="all"><input type="file" name="name" id="id" />
  156.  
  157. </form>

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