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at December 10, 2015 03:37 by kemikazii
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<html> <title>Kemoy Joseph</title> <body> <img src="kclg.jpg" height = "100"> <link href="form.css" rel="stylesheet" type "text/css"> <script type="text/javascript"> prompt("What is your name?") </script> <h1 style ="text-align:center"><b><u>Course Selection</u></b></h1> <h5>* is a required field</h5> <form id = "math"action="mailto:[email protected]" method="post" enctype="text/plain"> <input type="hidden" name="email" id="email"value="[email protected]" /><!--Inputs a hidden box for the email address--> <fieldset id="name"> <legend>Login</legend> <label class="login"> Username<span>*</span> <input type="text" id="user" name="user" /> </label> <label> Password<span>*</span> <input type="text" id="pass" name="pass" /> </label> </fieldset> <br clear="all"><fieldset id="address"> <legend>Name</legend> First Name<span>*</span> <input type="text" id="first" name="first" maxlength="15" /> </label> <br>Last Name<span>*</span> <input type="text" id="last" name="last" maxlength="15" /> </label></br> </fieldset></br> <fieldset id="cont"> <legend>Address</legend> Street<span>*</span> <input type="text" id="str" name="str" maxlength="20" /> </label> <br>City<span>*</span> <input type="text" id="city" name="city" maxlength="10" /> </label> <br>State<span>*</span> <input type="text" id="state" name="state" value = "NY" /> </label> <br>ZIP<span>*</span> <input type="text" id="zip" name="zip" maxlength="10" /> </label></br> </fieldset> <br clear="all"><fieldset id = "crs"> <legend>High School Courses Taken<span>*</span></legend> <b><u>Language</u></b> <select name="name" id="id"> <option value="value1">Spanish</option> <option value="value2">French</option> <option value="value2">No Language</option> </select> <br><br> <b><u>Field Related</u></b> <select multiple = "multiple"> <optgroup label="Business"> <option>Accounts</option> <option>Office Administration</option> <option>Business Administration</option> </optgroup> <optgroup label="Science"> <option>Biology</option> <option>Chemistry</option> <option>Physics</option> </optgroup> </select></br> <br><b><u>Main Courses</u></b> <label> <input type="checkbox" id="enga" name="enga" /> English Language </label> <label> <input type="checkbox" id="engb" name="engb" /> English Literature </label> <label> <input type="checkbox" id="mat" name="mat" /> Mathematics </label></br> <br><b><u>Electives</u></b></br> <label for="it">Information Technology</label> <input type="radio" name="sub" id="it" value="value1" /> <br><label for="art">Arts and Craft</label> <input type="radio" name="sub" id="art" value="value2" /> <br><label for="td">Technical Drawing</label> <input type="radio" name="sub" id="td" value="value3" /> <br><label for="art">None</label> <input type="radio" name="sub" id="none" value="value2" /></br> <br> <label for="comments" class="blockLabel"><b><u>Other Courses Taken</b></u></label> <textarea id="comments" name="comments"rows="5" cols="50"></textarea> </fieldset> <br clear="all"><fieldset> <legend>Major Selection<span>*</span></legend> <label for="cis">Computer Information Systems</label> <input type="radio" name="sub" id="cis" value="value1" /> <br><label for="act">Accounting</label> <input type="radio" name="sub" id="act" value="value2" /> <br><label for="cs">Computer Science</label> <input type="radio" name="sub" id="cs" value="value2" /> <br><label for="cj">Criminal Justice</label> <input type="radio" name="sub" id="cj" value="value2" /> </fieldset> <br clear="all"><fieldset> <legend>Course Selection(Spring 2014)<span>*</span></legend> <label> <input type="checkbox" id="cis22" name="cis22" /> CIS2200 </label> <br clear="all"><label> <input type="checkbox" id="cp11" name="cp11" /> CP1100 </label> <br clear="all"><label> <input type="checkbox" id="cp5" name="cp5" /> CP500 </label> <br clear="all"><label> <input type="checkbox" id="cis32" name="cis32" /> CIS3200 </label> <br clear="all"><label for="comments" class="blockLabel"><b><u>Comments</b></u></label> <textarea id="comments" name="comments"rows="5" cols="50"></textarea> </fieldset> <br clear="all"><input type="submit" value="Submit" /> <input type="reset" value="Reset" /> <br clear="all"> <br clear="all"><button name="home" id="home" value="home" type="button"> <img src="hmic.jpg" height = "30" width = "30" background = "grey"> Return to Home Page </button> <br clear="all"> <br clear="all"><input type="file" name="name" id="id" /> </form>
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A course registration form written in HTML
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Course Registration Form
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HTML