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

<div class="container">
    <div class="row">
        <div class="col-md-12">
            {!! $page_info->page_content_description !!}
            {{-- {!! $page_info !!} --}}
        </div>
    </div>
    @if ($isActive)
        <div class="row">
            <div class="col-md-12">
                <div style="border-top: 1px solid black; margin: 12px 12px"></div>
            </div>
            <div class="col-md-12">
                <form method="post" action="{{ route('public.scholarship.submit') }}" name="applicationForm" enctype="multipart/form-data" id="applicationForm" autocomplete="off">
                    {{csrf_field()}}
                    <b>Application Form
                    </b>
                    <div class="row">
                        <div class="col-md-4">
                            <div id="firstName">First Name: 
                            </div>
                            <input class="form-control" type="text" name="firstName" id="firstName"/>
                        </div>
                        <div class="col-md-4">
                            <div id="lastName">Last Name/Surname:
                            </div>
                            <input class="form-control" type="text" name="lastName" id="lastName"/>
                        </div>
                        <div class="col-md-4">
                            <div id="address">Street Address:
                            </div>
                            <input class="form-control" type="text" name="address" id="address"/>
                        </div>
                    </div>
                    <div class="row">
                        <div class="col-md-4">
                            <div id="city">City:
                            </div>
                            <input class="form-control" type="text" name="city" id="city"/>
                        </div>
                        <div class="col-md-4">
                            <div id="state">State:
                            </div>
                            <input class="form-control" type="text" name="state" id="state"/>
                        </div>
                        <div class="col-md-4">
                            <div id="zip">Zip Code:
                            </div>
                            <input class="form-control" type="text" name="zip" id="zip"/>
                        </div>
                    </div>
                    <div class="row">
                        <div class="col-md-6">
                            <div id="email">Email Address:
                            </div>
                            <input type="text" class="form-control" name="email" id="email"/>
                        </div>
                    </div>
                    <div class="row">
                        <div class="col-md-12">
                            <div id="essay">Write a 600-word essay that provides examples of your academic success and how access to resources (e.g., family support, financial resources) relates to education. 
                            </div>
                            <textarea class="form-control" name="essay" id="essay" style="height:160px; width: 100%"></textarea>
                        </div>
                    </div>
                    <div class="row">
                        <div class="col">
                            <input type="checkbox" name="resident" id="resident">
                                <label for="resident"> I verify that I am a resident of the United States and will be enrolled as a graduate student for the Fall 2024 semester.</label>
                        </div>
                    </div>
                    <div class="row">
                        <div class="col">
                            <input type="checkbox" name="first-gen" id="first-gen">
                                <label for="first-gen">I verify that I am a first-generation student [see terms for definition].</label>
                        </div>
                    </div>
                    <div class="row">
                        <div class="col">
                            <input type="checkbox" name="terms" id="terms">
                                <label for="terms">I verify that I have read all terms of the scholarship award.</label>
                        </div>
                    </div>
                    <div class="row py-3 justify-content-center">
                        <input type="submit" class="btn knowmad_btn_blue knowmad_btn" value="Submit">
                    </div>
                    <div class="row">
                        <div class="col-md-12" name="missingfields" id="missingfields" style="color: red">
                    </div>
                </form>
            </div>
        </div>
    @endif
</div>

    
@stop