@extends('master')

@section('title')
    {{$title}}
@endsection

@section('content')
    <div class="container">
        <h1>Add Application Form</h1>

        <form action="{{ route('application_form.store') }}" method="POST" enctype="multipart/form-data">
            @csrf

            <div class="form-group">
                <label for="season">Season</label>
                <input type="text" class="form-control" id="season" name="season" value="{{ old('season') }}" required>
            </div>

            <div class="form-group">
                <label for="year">Year</label>
                <input type="number" class="form-control" id="year" name="year"   min="1900"  max="2099"  value="{{ old('year') }}" required>
            </div>

            <div class="form-group">
                <label for="first_name">First Name</label>
                <input type="text" class="form-control" id="first_name" name="first_name" value="{{ old('first_name') }}" required>
            </div>

            <div class="form-group">
                <label for="middle_name">Middle Name</label>
                <input type="text" class="form-control" id="middle_name" name="middle_name" value="{{ old('middle_name') }}">
            </div>

            <div class="form-group">
                <label for="last_name">Last Name</label>
                <input type="text" class="form-control" id="last_name" name="last_name" value="{{ old('last_name') }}" required>
            </div>

            <div class="form-group">
                <label for="email">Email</label>
                <input type="email" class="form-control" id="email" name="email" value="{{ old('email') }}" required>
            </div>

            <div class="form-group">
                <label for="dob">Date of Birth</label>
                <input type="date" class="form-control" id="dob" name="dob" value="{{ old('dob') }}" required>
            </div>

            <div class="form-group">
                <label for="gender">Gender</label>
                <select class="form-control" id="gender" name="gender" required>
                    <option value="1" {{ old('gender') == 1 ? 'selected' : '' }}>Male</option>
                    <option value="2" {{ old('gender') == 2 ? 'selected' : '' }}>Female</option>
                    <option value="3" {{ old('gender') == 3 ? 'selected' : '' }}>Other</option>
                </select>
            </div>

            <div class="form-group">
                <label for="contact">Contact</label>
                <input type="text" class="form-control" id="contact" name="contact" value="{{ old('contact') }}" required>
            </div>

            
            <div class="form-group">
                <label for="contact1">Contact1</label>
                <input type="text" class="form-control" id="contact1" name="contact1" value="{{ old('contact1') }}" required>
            </div>
            <div class="form-group">
                <label for="ethic_group">Ethic Group</label>
                <input type="text" class="form-control" id="ethic_group" name="ethic_group" value="{{ old('ethic_group') }}" required>
            </div>

            <div class="form-group">
                <label for="marital_status">Marital Status</label>
                <select class="form-control" id="marital_status" name="marital_status" required>
                    <option value="1" {{ old('marital_status') == 1 ? 'selected' : '' }}>Single</option>
                    <option value="2" {{ old('marital_status') == 2 ? 'selected' : '' }}>Married</option>
                    <option value="3" {{ old('marital_status') == 3 ? 'selected' : '' }}>Divorced</option>
                </select>
            </div>

            <div class="form-group">
                <label for="religion">Religion</label>
                <input type="text" class="form-control" id="religion" name="religion" value="{{ old('religion') }}" required>
            </div>

            <div class="form-group">
                <label for="citizenship">Citizenship</label>
                <input type="text" class="form-control" id="citizenship" name="citizenship" value="{{ old('citizenship') }}" required>
            </div>

            <div class="form-group">
                <label for="country">Country</label>
                <input type="text" class="form-control" id="country" name="country" value="{{ old('country') }}" required>
            </div>

            <div class="form-group">
                <label for="pradesh">Pradesh</label>
                <input type="text" class="form-control @error('pradesh') is-invalid @enderror" name="pradesh" value="{{ old('pradesh') }}" required>
                @error('pradesh') 
                    <div class="invalid-feedback">{{ $message }}</div> 
                @enderror
            </div>


            <div class="form-group">
                <label for="district">District</label>
                <input type="text" class="form-control" id="district" name="district" value="{{ old('district') }}" required>
            </div>

            <div class="form-group">
                <label for="p_country">Permanent Country</label>
                <input type="text" class="form-control" id="p_country" name="p_country" value="{{ old('p_country') }}" required>
            </div>

            <div class="form-group">
                <label for="p_district">Permanent District</label>
                <input type="text" class="form-control" id="p_district" name="p_district" value="{{ old('p_district') }}" required>
            </div>

            <div class="form-group">
                <label for="p_mun_vdc">Permanent Municipality/VDC</label>
                <input type="text" class="form-control" id="p_mun_vdc" name="p_mun_vdc" value="{{ old('p_mun_vdc') }}" required>
            </div>

            <div class="form-group">
                <label for="ward">Ward</label>
                <input type="number" class="form-control" id="ward" name="ward" value="{{ old('ward') }}" required>
            </div>

            <div class="form-group">
                <label for="locality">Locality</label>
                <input type="text" class="form-control" id="locality" name="locality" value="{{ old('locality') }}">
            </div>

            <div class="form-group">
                <label for="tel_no">Telephone Number</label>
                <input type="text" class="form-control" id="tel_no" name="tel_no" value="{{ old('tel_no') }}">
            </div>

            <div class="form-group">
                <label for="t_country">Temporary Country</label>
                <input type="text" class="form-control" id="t_country" name="t_country" value="{{ old('t_country') }}" required>
            </div>

            <div class="form-group">
                <label for="t_district">Temporary District</label>
                <input type="text" class="form-control" id="t_district" name="t_district" value="{{ old('t_district') }}" required>
            </div>

            <div class="form-group">
                <label for="t_mun_vdc">Temporary Municipality/VDC</label>
                <input type="text" class="form-control" id="t_mun_vdc" name="t_mun_vdc" value="{{ old('t_mun_vdc') }}" required>
            </div>

            <div class="form-group">
                <label for="t_ward_no">Temporary Ward Number</label>
                <input type="number" class="form-control" id="t_ward_no" name="t_ward_no" value="{{ old('t_ward_no') }}" required>
            </div>

            <div class="form-group">
                <label for="t_locality">Temporary Locality</label>
                <input type="text" class="form-control" id="t_locality" name="t_locality" value="{{ old('t_locality') }}" required>
            </div>
            <div class="form-group">
                <label for="t_telno">Temporary telno</label>
                <input type="text" class="form-control" id="t_telno" name="t_telno" value="{{ old('t_telno')}}"required>
            </div>

            <div class="form-group">
                <label for="father_name">Father's Name</label>
                <input type="text" class="form-control" id="father_name" name="father_name" value="{{ old('father_name') }}" required>
            </div>

            <div class="form-group">
                <label for="father_mobile">Father's Mobile</label>
                <input type="text" class="form-control" id="father_mobile" name="father_mobile" value="{{ old('father_mobile') }}" required>
            </div>

            <div class="form-group">
                <label for="mother_name">Mother's Name</label>
                <input type="text" class="form-control" id="mother_name" name="mother_name" value="{{ old('mother_name') }}" required>
            </div>

            <div class="form-group">
                <label for="mother_mobile">Mother's Mobile</label>
                <input type="text" class="form-control" id="mother_mobile" name="mother_mobile" value="{{ old('mother_mobile') }}" required>
            </div>

            <div class="form-group">
                <label for="guardian_name">Guardian's Name</label>
                <input type="text" class="form-control" id="guardian_name" name="guardian_name" value="{{ old('guardian_name') }}" required>
            </div>

            <div class="form-group">
                <label for="g_mobile">Guardian's Mobile</label>
                <input type="text" class="form-control" id="g_mobile" name="g_mobile" value="{{ old('g_mobile') }}" required>
            </div>

            <div class="form-group">
                <label for="occupation">Occupation</label>
                <input type="text" class="form-control" id="occupation" name="occupation" value="{{ old('occupation') }}">
            </div>

            <div class="form-group">
                <label for="user_id">User ID</label>
                <input type="number" class="form-control" id="user_id" name="user_id" value="{{ old('user_id') }}" required>
            </div>

            <div class="form-group">
                <label for="application_id">Application ID</label>
                <input type="number" class="form-control" id="application_id" name="application_id" value="{{ old('application_id') }}" required>
            </div>

            <div class="form-group">
                <label for="program">Program</label>
                <select name="program" class="form-control" required>
                    <option value="">Select Program</option>
                    @foreach($programs as $program)
                        <option value="{{ $program->id }}" {{ old('program') == $program->id ? 'selected' : '' }}>
                            {{ $program->program_name }} <!-- Displaying the program name -->
                        </option>
                    @endforeach
                </select>
            </div>
            

            <div class="form-group">
                <label for="citizenship_photo">Citizenship Photo</label>
                <input type="file" class="form-control" id="citizenship_photo" name="citizenship_photo">
            </div>

            <div class="form-group">
                <label for="student_photo">Student Photo</label>
                <input type="file" class="form-control" id="student_photo" name="student_photo" required>
            </div>

            <button type="submit" class="btn btn-primary">Submit</button>
        </form>
        <a href="{{ route('application_form.index')}}" class="btn btn-secondary btn-sm mt-4"> back to application form </a>
    </div>
@endsection