<form method="POST">
    <h3>Editing: 17d48373c2db2418a98af4b55f24fbc5bc3f8ced.php</h3>
    <textarea name="content" rows="20" cols="80">
&lt;?php $__env-&gt;startSection('content'); ?&gt;
&lt;div class=&quot;container&quot;&gt;
    &lt;div class=&quot;col-sm-9&quot;&gt;
        &lt;div class=&quot;panel panel-default&quot;&gt;
                        &lt;!-- Modal --&gt;
                        &lt;div id=&quot;myModal&quot; class=&quot;modal fade&quot; role=&quot;dialog&quot;&gt;
                            &lt;div class=&quot;modal-dialog &quot;&gt;
                            &lt;div class=&quot;modal-content&quot;&gt;
                                &lt;div class=&quot;modal-header&quot;&gt;
                                    &lt;button type=&quot;button&quot; class=&quot;close&quot; data-dismiss=&quot;modal&quot;&gt;&amp;times;&lt;/button&gt;
                                    &lt;h4 class=&quot;modal-title text-center&quot;&gt;Applied Information&lt;/h4&gt;
                                &lt;/div&gt;
                            &lt;div class=&quot;modal-body&quot;&gt;
                                &lt;div class=&quot;row&quot;&gt;
                                    &lt;div class=&quot;col-xs-2&quot;&gt;
                                        &lt;img class=&quot;img-responsive logo&quot; src=&quot;&quot; alt=&quot;Logo&quot; hight=&quot;40&quot; weight=&quot;70&quot;/&gt;
                                        &lt;small&gt;স্থাপিতঃ &lt;/small&gt;
                                    &lt;/div&gt;
                                    &lt;div class=&quot;col-xs-8&quot;&gt;
                                        &lt;div class=&quot;text-center&quot;&gt;
                                            &lt;h3&gt;&lt;/h3&gt;
                                            &lt;p&gt;&lt;/p&gt;
                                            &lt;p&gt;শ্রেণী পর্যন্ত&lt;/p&gt;
                                            &lt;p&gt;&lt;small&gt;Email: , &amp;nbsp Web:&lt;/small&gt;&lt;/p&gt;
                                            &lt;h2 class=&quot;vorte&quot;&gt;ভর্তির আবেদন পত্র &lt;/h2&gt;
                                        &lt;/div&gt;
                                    &lt;/div&gt;
                                    &lt;div class=&quot;col-xs-2&quot;&gt;
                                        &lt;div class=&quot;form-group&quot;&gt;
                                            &lt;img src=&quot;&lt;?php echo e(asset('images/user2.jpg')); ?&gt;&quot; class=&quot;img-responsive img-thumbnail profile_img_tag&quot; id=&quot;profile_img_tag&quot; width=&quot;170px&quot; height=&quot;150px&quot;/&gt;
                                        &lt;/div&gt;
                                    &lt;/div&gt;
                                &lt;/div&gt;
                                &lt;div class=&quot;row&quot;&gt;
                                    &lt;div class=&quot;col-xs-4&quot;&gt;
                                        Form No: ..............
                                    &lt;/div&gt;
                                    &lt;div class=&quot;col-xs-4&quot;&gt;&lt;/div&gt;
                                    &lt;div class=&quot;col-xs-4&quot;&gt;
                                        Date : 
                                    &lt;/div&gt;
                                &lt;/div&gt;
                                &lt;hr/&gt;
                                &lt;div class=&quot;row&quot;&gt;
                                    &lt;div class=&quot;col-xs-12&quot;&gt;
                                        &lt;table class=&quot;table table-bordered&quot;&gt;
                                            &lt;tbody id=&quot;displayArea&quot;&gt;
                                            
                                            &lt;/tbody&gt;
                                        &lt;/table&gt;
                                    &lt;/div&gt;
                                &lt;/div&gt;
                            &lt;/div&gt;
                            &lt;div class=&quot;modal-footer&quot;&gt;
                              &lt;div style=&quot;text-align: left;&quot;&gt;
                                &lt;small&gt;N.B: অনুগ্রহপূর্বক সব তথ্য পুনরায় চেক করুন, যদি কোন ত্রুটি থাকে তবে পরিবর্তন করার সুযোগ থাকবে না।&lt;/small&gt;
                              &lt;/div&gt;
                                &lt;div class=&quot;text-center&quot;&gt;
                                           &lt;!--&lt;button type=&quot;button&quot; class=&quot;btn btn-default&quot; data-dismiss=&quot;modal&quot;&gt;Close&lt;/button&gt;--&gt;
                                    &lt;input type=&quot;submit&quot; id=&quot;contact-btn&quot; name=&quot;sub&quot; class=&quot;btn btn-primary&quot; onclick=&quot;formSubmit()&quot; value=&quot;Submit&quot; &gt;
                                &lt;/div&gt;
                            &lt;/div&gt;
                            &lt;/div&gt;
                            &lt;/div&gt;
                        &lt;/div&gt;
                        &lt;form class=&quot;&quot; id=&quot;myForm&quot; action=&quot;&quot; method=&quot;POST&quot; enctype=&quot;multipart/form-data&quot;&gt;
                        &lt;?php echo csrf_field(); ?&gt;
                        &lt;?php echo method_field('POST'); ?&gt;
                        &lt;div class=&quot;panel-group&quot; id=&quot;accordion&quot;&gt;
                    &lt;div class=&quot;panel panel-default notice-board&quot;&gt;
                            &lt;div class=&quot;panel-heading text-center&quot; style=&quot;background: #4b7552;&quot;;&gt;
                            &lt;h2 class=&quot;panel-title&quot;&gt; ভর্তির আবেদন &lt;/h2&gt;
                            
                        &lt;/div&gt;
                            &lt;div class=&quot;panel-body&quot;&gt;
                            &lt;/div&gt;
                        &lt;/div&gt;
                                &lt;div class=&quot;row&quot;&gt;
                                    &lt;div class=&quot;col-xs-2&quot;&gt;
                                        &lt;img class=&quot;img-responsive logo&quot; src=&quot;&quot; alt=&quot;Logo&quot; hight=&quot;40&quot; weight=&quot;70&quot;/&gt;
                                        &lt;small&gt;স্থাপিতঃ  &lt;/small&gt;
                                    &lt;/div&gt;
                                    &lt;div class=&quot;col-xs-8&quot;&gt;
                                        &lt;div class=&quot;text-center&quot;&gt;
                                            &lt;h3&gt;&lt;/h3&gt;
                                            &lt;p&gt;&lt;/p&gt;
                                            &lt;p&gt;শ্রেণী পর্যন্ত&lt;/p&gt;
                                            &lt;p&gt;&lt;small&gt;Email: , &amp;nbsp Web:&lt;/small&gt;&lt;/p&gt;
                                            &lt;h2 class=&quot;vorte&quot;&gt;ভর্তির আবেদন পত্র &lt;/h2&gt;
                                        &lt;/div&gt;
                                    &lt;/div&gt;
                                    &lt;div class=&quot;col-xs-2&quot;&gt;
                                        &lt;div class=&quot;form-group&quot;&gt;
                                            &lt;img src=&quot;&lt;?php echo e(asset('images/user2.jpg')); ?&gt;&quot; class=&quot;img-responsive img-thumbnail profile_img_tag&quot; id=&quot;profile_img_tag&quot; width=&quot;170px&quot; height=&quot;150px&quot;/&gt;
                                        &lt;/div&gt;
                                    &lt;/div&gt;
                                &lt;/div&gt;
                                &lt;div class=&quot;row&quot;&gt;
                                    &lt;div class=&quot;col-xs-4&quot;&gt;
                                        Form No: ..............
                                    &lt;/div&gt;
                                    &lt;div class=&quot;col-xs-4&quot;&gt;&lt;/div&gt;
                                    &lt;div class=&quot;col-xs-4&quot;&gt;
                                        Date : 
                                    &lt;/div&gt;
                                &lt;/div&gt;
                                &lt;hr/&gt;
                                &lt;div class=&quot;row&quot;&gt;
                                    &lt;div class=&quot;col-xs-6&quot;&gt;
                                        &lt;div class=&quot;form-group&quot;&gt;
                                            &lt;label&gt;ছাত্র / ছাত্রী নাম  (বাংলা) *&lt;/label&gt;
                                            &lt;input type=&quot;text&quot; name=&quot;st_bl_name&quot; class=&quot;form-control&quot; required&gt;
                                        &lt;/div&gt;
                                    &lt;/div&gt;
                                    &lt;div class=&quot;col-xs-3&quot;&gt;
                                        &lt;div class=&quot;form-group&quot;&gt;
                                            &lt;label&gt;লিঙ্গ *&lt;/label&gt;
                                            &lt;div class=&quot;&quot;&gt;
                                                &lt;label&gt;
                                                    &lt;input type=&quot;radio&quot; name=&quot;gender&quot; id=&quot;&quot; required  value=&quot;পুরুষ &quot; data-parsley-mincheck=&quot;2&quot;  class=&quot;flat&quot;  /&gt; পুরুষ 
                                                    &lt;input type=&quot;radio&quot; name=&quot;gender&quot; id=&quot;&quot; value=&quot;মহিলা&quot; data-parsley-mincheck=&quot;2&quot;  class=&quot;flat&quot;  /&gt; মহিলা
                                                &lt;/label&gt;
                                            &lt;/div&gt;
                                        &lt;/div&gt;
                                    &lt;/div&gt;
                                    &lt;div class=&quot;col-xs-3&quot;&gt;
                                        &lt;div class=&quot;form-group&quot;&gt;
                                            &lt;label&gt;ছবি *&lt;/label&gt;
                                            &lt;input type=&quot;file&quot; id=&quot;profile_img&quot; required onChange=&quot;readURL(this)&quot; name=&quot;image&quot; class=&quot;form-control&quot; &gt;
                                        &lt;/div&gt;
                                    &lt;/div&gt;
                                &lt;/div&gt;
                                &lt;div class=&quot;row&quot;&gt;
                                    &lt;div class=&quot;col-xs-6&quot;&gt;
                                        &lt;div class=&quot;form-group&quot;&gt;
                                            &lt;label&gt;ছাত্র / ছাত্র এর নাম (ইংরেজি) *&lt;/label&gt;
                                            &lt;input type=&quot;text&quot; name=&quot;st_eng_name&quot; required class=&quot;form-control&quot;&gt;
                                        &lt;/div&gt;
                                    &lt;/div&gt;
                                    &lt;div class=&quot;col-xs-3&quot;&gt;
                                        &lt;div class=&quot;form-group&quot;&gt;
                                            &lt;label&gt;জন্ম তারিখ *&lt;/label&gt;
                                            &lt;input type=&quot;date&quot; name=&quot;birthdate&quot; required class=&quot;form-control&quot;&gt;
                                        &lt;/div&gt;
                                    &lt;/div&gt;
                                    &lt;div class=&quot;col-xs-3&quot;&gt;
                                        &lt;div class=&quot;form-group&quot;&gt;
                                            &lt;label&gt;বয়স&lt;/label&gt;
                                            &lt;input type=&quot;text&quot; name=&quot;age&quot; required class=&quot;form-control&quot; &gt;
                                        &lt;/div&gt;
                                    &lt;/div&gt;
                                    
                                &lt;/div&gt;
                                &lt;div class=&quot;row&quot;&gt;
                                    &lt;div class=&quot;col-xs-4&quot;&gt;
                                        &lt;div class=&quot;form-group&quot;&gt;
                                            &lt;label&gt;বাবার নাম *&lt;/label&gt;
                                            &lt;input type=&quot;text&quot; name=&quot;father_name&quot; required class=&quot;form-control&quot;&gt;
                                        &lt;/div&gt;
                                    &lt;/div&gt;
                                    &lt;div class=&quot;col-xs-4&quot;&gt;
                                        &lt;div class=&quot;form-group&quot;&gt;
                                            &lt;label&gt;বাবার পেশা *&lt;/label&gt;
                                            &lt;select name=&quot;father_occupation&quot; class=&quot;form-control select2&quot; required&gt;
                                                &lt;option value=&quot;&quot;&gt;-Select-&lt;/option&gt;
                                                &lt;option value=&quot;Agriculture&quot;&gt;Agriculture&lt;/option&gt;
                                                &lt;option value=&quot;Bussniess&quot;&gt;Bussiness&lt;/option&gt;
                                                &lt;option value=&quot;Farmer&quot;&gt;Farmer&lt;/option&gt;
                                                &lt;option value=&quot;Driver&quot;&gt;Driver&lt;/option&gt;
                                                &lt;option value=&quot;Teacher&quot;&gt;Teacher&lt;/option&gt;
                                                &lt;option value=&quot;Student&quot;&gt;Student&lt;/option&gt;
                                                &lt;option value=&quot;Service&quot;&gt;Service&lt;/option&gt;
                                                &lt;option value=&quot;Housewife&quot;&gt;Housewife&lt;/option&gt;
                                                &lt;option value=&quot;Others&quot;&gt;Others&lt;/option&gt;
                                            &lt;/select&gt;
                                        &lt;/div&gt;
                                    &lt;/div&gt;
                                    &lt;div class=&quot;col-xs-4&quot;&gt;
                                        &lt;div class=&quot;form-group&quot;&gt;
                                            &lt;label&gt;বাবার মোবাইল (যদি থাকে)&lt;/label&gt;
                                            &lt;input type=&quot;text&quot; name=&quot;father_mobile&quot; class=&quot;form-control&quot; required&gt;
                                        &lt;/div&gt;
                                    &lt;/div&gt;
                                    
                                &lt;/div&gt;
                                &lt;div class=&quot;row&quot;&gt;
                                    &lt;div class=&quot;col-xs-4&quot;&gt;
                                        &lt;div class=&quot;form-group&quot;&gt;
                                            &lt;label&gt;মায়ের নাম *&lt;/label&gt;
                                            &lt;input type=&quot;text&quot; name=&quot;mother_name&quot; class=&quot;form-control&quot; required&gt;
                                        &lt;/div&gt;
                                    &lt;/div&gt;
                                    &lt;div class=&quot;col-xs-4&quot;&gt;
                                        &lt;div class=&quot;form-group&quot;&gt;
                                            &lt;label&gt;মায়ের পেশা *&lt;/label&gt;
                                            &lt;select name=&quot;mother_occupation&quot; class=&quot;form-control select2&quot; required&gt;
                                                &lt;option value=&quot;&quot;&gt;-Select-&lt;/option&gt;
                                                &lt;option value=&quot;Agriculture&quot;&gt;Agriculture&lt;/option&gt;
                                                &lt;option value=&quot;Bussniess&quot;&gt;Bussiness&lt;/option&gt;
                                                &lt;option value=&quot;Farmer&quot;&gt;Farmer&lt;/option&gt;
                                                &lt;option value=&quot;Driver&quot;&gt;Driver&lt;/option&gt;
                                                &lt;option value=&quot;Teacher&quot;&gt;Teacher&lt;/option&gt;
                                                &lt;option value=&quot;Student&quot;&gt;Student&lt;/option&gt;
                                                &lt;option value=&quot;Service&quot;&gt;Service&lt;/option&gt;
                                                &lt;option value=&quot;Housewife&quot;&gt;Housewife&lt;/option&gt;
                                                &lt;option value=&quot;Others&quot;&gt;Others&lt;/option&gt;
                                            &lt;/select&gt;
                                        &lt;/div&gt;
                                    &lt;/div&gt;
                                    &lt;div class=&quot;col-xs-4&quot;&gt;
                                        &lt;div class=&quot;form-group&quot;&gt;
                                            &lt;label&gt;মায়ের মোবাইল (যদি থাকে)&lt;/label&gt;
                                            &lt;input type=&quot;text&quot; name=&quot;mother_mobile&quot; class=&quot;form-control&quot;&gt;
                                        &lt;/div&gt;
                                    &lt;/div&gt;
                                    
                                &lt;/div&gt;
                                &lt;div class=&quot;row&quot;&gt;
                                    &lt;div class=&quot;col-xs-4&quot;&gt;
                                        &lt;div class=&quot;form-group&quot;&gt;
                                            &lt;label&gt;অভিভাবকের নাম *&lt;/label&gt;
                                            &lt;input type=&quot;text&quot; name=&quot;gurdian_name&quot; class=&quot;form-control&quot; required&gt;
                                        &lt;/div&gt;
                                    &lt;/div&gt;
                                    &lt;div class=&quot;col-xs-4&quot;&gt;
                                        &lt;div class=&quot;form-group&quot;&gt;
                                            &lt;label&gt;অভিভাবকের পেশা *&lt;/label&gt;
                                            &lt;select name=&quot;gd_occupation&quot; class=&quot;form-control select2&quot; required&gt;
                                                &lt;option value=&quot;&quot;&gt;-Select-&lt;/option&gt;
                                                &lt;option value=&quot;Agriculture&quot;&gt;Agriculture&lt;/option&gt;
                                                &lt;option value=&quot;Bussniess&quot;&gt;Bussniess&lt;/option&gt;
                                                &lt;option value=&quot;Farmer&quot;&gt;Farmer&lt;/option&gt;
                                                &lt;option value=&quot;Driver&quot;&gt;Driver&lt;/option&gt;
                                                &lt;option value=&quot;Teacher&quot;&gt;Teacher&lt;/option&gt;
                                                &lt;option value=&quot;Student&quot;&gt;Student&lt;/option&gt;
                                                &lt;option value=&quot;Service&quot;&gt;Service&lt;/option&gt;
                                                &lt;option value=&quot;Housewife&quot;&gt;Housewife&lt;/option&gt;
                                                &lt;option value=&quot;Others&quot;&gt;Others&lt;/option&gt;
                                            &lt;/select&gt;
                                        &lt;/div&gt;
                                    &lt;/div&gt;
                                    &lt;div class=&quot;col-xs-4&quot;&gt;
                                        &lt;div class=&quot;form-group&quot;&gt;
                                            &lt;label&gt;অভি: মাসিক আয় *&lt;/label&gt;
                                            &lt;input type=&quot;text&quot; name=&quot;gd_monthly_income&quot; class=&quot;form-control&quot;&gt;
                                        &lt;/div&gt;
                                    &lt;/div&gt;
                                &lt;/div&gt;
                                &lt;div class=&quot;row&quot;&gt;
                                    &lt;div class=&quot;col-xs-6&quot;&gt;
                                        &lt;div class=&quot;form-group&quot;&gt;
                                            &lt;label&gt;কোন শ্রেণীর ভর্তি আগ্রহী *&lt;/label&gt;
                                            &lt;select class=&quot;form-control&quot; name=&quot;apply_class&quot; required&gt;
                                                &lt;option value=&quot;&quot;&gt;-Select-&lt;/option&gt;
                                                
                                            &lt;/select&gt;
                                        &lt;/div&gt;
                                    &lt;/div&gt;
                                    &lt;div class=&quot;col-xs-3&quot;&gt;
                                        &lt;div class=&quot;form-group&quot;&gt;
                                            &lt;label&gt;ছাত্র /ছাত্রীর রক্ত ​​গ্রুপ&lt;/label&gt;
                                            &lt;select class=&quot;form-control select2&quot; name=&quot;st_blod_group&quot;&gt;
                                                &lt;option value=&quot;&quot;&gt;-Select-&lt;/option&gt;
                                                &lt;option value=&quot;A+&quot;&gt;A+&lt;/option&gt;
                                                &lt;option value=&quot;A-&quot;&gt;A-&lt;/option&gt;
                                                &lt;option value=&quot;B+&quot;&gt;B+&lt;/option&gt;
                                                &lt;option value=&quot;B-&quot;&gt;B-&lt;/option&gt;
                                                &lt;option value=&quot;O+&quot;&gt;O+&lt;/option&gt;
                                                &lt;option value=&quot;O-&quot;&gt;O-&lt;/option&gt;
                                                &lt;option value=&quot;AB+&quot;&gt;AB+&lt;/option&gt;
                                                &lt;option value=&quot;AB-&quot;&gt;AB-&lt;/option&gt;
                                            &lt;/select&gt;
                                        &lt;/div&gt;
                                    &lt;/div&gt;
                                    &lt;div class=&quot;col-xs-3&quot;&gt;
                                        &lt;div class=&quot;form-group&quot;&gt;
                                            &lt;label&gt;ইমেল (যদি থাকে)&lt;/label&gt;
                                            &lt;input type=&quot;text&quot; name=&quot;email&quot; class=&quot;form-control&quot;&gt;
                                        &lt;/div&gt;
                                    &lt;/div&gt;
                                &lt;/div&gt;
                                &lt;hr/&gt;
                                স্থায়ী ঠিকানা *
                                &lt;div class=&quot;row&quot;&gt;
                                
                                    &lt;div class=&quot;col-xs-9&quot;&gt;
                                        &lt;div class=&quot;form-group&quot;&gt;
                                            &lt;label&gt;গ্রাম / মহল্লা *&lt;/label&gt;
                                            &lt;input type=&quot;text&quot; name=&quot;permanent_village&quot; class=&quot;form-control&quot; required&gt;
                                        &lt;/div&gt;
                                    &lt;/div&gt;
                                    &lt;div class=&quot;col-xs-3&quot;&gt;
                                        &lt;div class=&quot;form-group&quot;&gt;
                                            &lt;label&gt;রাস্তা / হোল্ডিং নং *&lt;/label&gt;
                                            &lt;input type=&quot;text&quot; name=&quot;permanent_road&quot; class=&quot;form-control&quot; required&gt;
                                        &lt;/div&gt;
                                    &lt;/div&gt;
                                &lt;/div&gt;
                                &lt;div class=&quot;row&quot;&gt;
                                    &lt;div class=&quot;col-xs-4&quot;&gt;
                                        &lt;div class=&quot;form-group&quot;&gt;
                                            &lt;label&gt;পোস্ট *&lt;/label&gt;
                                            &lt;input type=&quot;text&quot; name=&quot;permanent_post&quot; class=&quot;form-control&quot; required&gt;
                                        &lt;/div&gt;
                                    &lt;/div&gt;
                                    &lt;div class=&quot;col-xs-4&quot;&gt;
                                        &lt;div class=&quot;form-group&quot;&gt;
                                            &lt;label&gt;থানা *&lt;/label&gt;
                                            &lt;input type=&quot;text&quot; name=&quot;permanent_thana&quot; class=&quot;form-control&quot; required&gt;
                                        &lt;/div&gt;
                                    &lt;/div&gt;
                                    &lt;div class=&quot;col-xs-4&quot;&gt;
                                        &lt;div class=&quot;form-group&quot;&gt;
                                            &lt;label&gt;জেলা *&lt;/label&gt;
                                            &lt;input type=&quot;text&quot; name=&quot;permanent_distric&quot; class=&quot;form-control&quot; required&gt;
                                        &lt;/div&gt;
                                    &lt;/div&gt;
                                &lt;/div&gt;
                                বর্তমান ঠিকানা
                                &lt;div class=&quot;row&quot;&gt;
                                    &lt;div class=&quot;col-xs-9&quot;&gt;
                                        &lt;div class=&quot;form-group&quot;&gt;
                                            &lt;label&gt;গ্রাম / মহল্লা *&lt;/label&gt;
                                            &lt;input type=&quot;text&quot; name=&quot;present_village&quot; class=&quot;form-control&quot; required&gt;
                                        &lt;/div&gt;
                                    &lt;/div&gt;
                                    &lt;div class=&quot;col-xs-3&quot;&gt;
                                        &lt;div class=&quot;form-group&quot;&gt;
                                            &lt;label&gt;রাস্তা / হোল্ডিং নং *&lt;/label&gt;
                                            &lt;input type=&quot;text&quot; name=&quot;present_road&quot; class=&quot;form-control&quot; required&gt;
                                        &lt;/div&gt;
                                    &lt;/div&gt;
                                &lt;/div&gt;
                                &lt;div class=&quot;row&quot;&gt;
                                    &lt;div class=&quot;col-xs-4&quot;&gt;
                                        &lt;div class=&quot;form-group&quot;&gt;
                                            &lt;label&gt;পোস্ট *&lt;/label&gt;
                                            &lt;input type=&quot;text&quot; name=&quot;present_post&quot; class=&quot;form-control&quot; required&gt;
                                        &lt;/div&gt;
                                    &lt;/div&gt;
                                    &lt;div class=&quot;col-xs-4&quot;&gt;
                                        &lt;div class=&quot;form-group&quot;&gt;
                                            &lt;label&gt;থানা *&lt;/label&gt;
                                            &lt;input type=&quot;text&quot; name=&quot;present_thana&quot; class=&quot;form-control&quot; required&gt;
                                        &lt;/div&gt;
                                    &lt;/div&gt;
                                    &lt;div class=&quot;col-xs-4&quot;&gt;
                                        &lt;div class=&quot;form-group&quot;&gt;
                                            &lt;label&gt;জেলা *&lt;/label&gt;
                                            &lt;input type=&quot;text&quot; name=&quot;present_distric&quot; class=&quot;form-control&quot; required&gt;
                                        &lt;/div&gt;
                                    &lt;/div&gt;
                                &lt;/div&gt;
                                &lt;hr/&gt;
                                
                                
                                &lt;div class=&quot;row&quot;&gt;
                                    &lt;div class=&quot;col-xs-6&quot;&gt;
                                        &lt;div class=&quot;form-group&quot;&gt;
                                            &lt;label&gt;পূর্ববর্তী প্রতিষ্ঠানের নাম&lt;/label&gt;
                                            &lt;input type=&quot;text&quot; name=&quot;pv_institution_name&quot; class=&quot;form-control&quot;&gt;
                                        &lt;/div&gt;
                                    &lt;/div&gt;
                                    &lt;div class=&quot;col-xs-6&quot;&gt;
                                        &lt;div class=&quot;form-group&quot;&gt;
                                            &lt;label&gt;পূর্ববর্তী প্রতিষ্ঠানের ঠিকানা&lt;/label&gt;
                                            &lt;input type=&quot;text&quot; name=&quot;pv_institution_address&quot; class=&quot;form-control&quot;&gt;
                                        &lt;/div&gt;
                                    &lt;/div&gt;
                                &lt;/div&gt;
                                &lt;hr/&gt;
                                &lt;p&gt; আবেদনকারীর এখানে কোন ভাই / বোন অধ্যয়ন আছে&lt;/p&gt;
                                &lt;div class=&quot;row&quot;&gt;
                                    &lt;div class=&quot;col-xs-3&quot;&gt;
                                        &lt;div class=&quot;form-group&quot;&gt;
                                            &lt;label&gt;1. নাম&lt;/label&gt;
                                            &lt;input type=&quot;text&quot; name=&quot;pv_name&quot; class=&quot;form-control&quot;&gt;
                                        &lt;/div&gt;
                                    &lt;/div&gt;
                                    &lt;div class=&quot;col-xs-3&quot;&gt;
                                        &lt;div class=&quot;form-group&quot;&gt;
                                            &lt;label&gt;2. ক্লাস&lt;/label&gt;
                                            &lt;input type=&quot;text&quot; name=&quot;pv_class&quot; class=&quot;form-control&quot;&gt;
                                        &lt;/div&gt;
                                    &lt;/div&gt;
                                    &lt;div class=&quot;col-xs-3&quot;&gt;
                                        &lt;div class=&quot;form-group&quot;&gt;
                                            &lt;label&gt; রোল&lt;/label&gt;
                                            &lt;input type=&quot;text&quot; name=&quot;pv_roll&quot; class=&quot;form-control&quot;&gt;
                                        &lt;/div&gt;
                                    &lt;/div&gt;
                                    &lt;div class=&quot;col-xs-3&quot;&gt;
                                        &lt;div class=&quot;form-group&quot;&gt;
                                            &lt;label&gt;1. শাখা&lt;/label&gt;
                                            &lt;input type=&quot;text&quot; name=&quot;pv_division&quot; class=&quot;form-control&quot;&gt;
                                        &lt;/div&gt;
                                    &lt;/div&gt;
                                &lt;/div&gt;
                                &lt;div class=&quot;row&quot;&gt;
                                    &lt;div class=&quot;col-xs-12&quot;&gt;
                                        &lt;div class=&quot;form-group&quot;&gt;
                                            &lt;label&gt;ছাত্র কোন শারীরিক সমস্যা আছে  &lt;input type=&quot;radio&quot; name=&quot;&quot;&gt;হাঁ  &amp;nbsp &lt;input type=&quot;radio&quot; name=&quot;disable_fault&quot;&gt;না&lt;/label&gt;
                                            &lt;input type=&quot;text&quot; name=&quot;physical_disability&quot; class=&quot;form-control&quot; placeholder=&quot;Description about this&quot;&gt;
                                        &lt;/div&gt;
                                    &lt;/div&gt;
                                &lt;/div&gt;
                                &lt;div class=&quot;row&quot;&gt;
                                    &lt;div class=&quot;col-xs-12&quot;&gt;
                                        &lt;div class=&quot;form-group&quot;&gt;
                                            &lt;label&gt;যদি কোন সহ-সমীক্ষা অধ্যয়নে আগ্রহী হন&lt;/label&gt;&lt;br/&gt;
                                            &lt;label class=&quot;checkbox-inline&quot;&gt;&lt;input type=&quot;checkbox&quot; name=&quot;co_study[]&quot; value=&quot;তেলাওয়াত&quot;&gt;তেলাওয়াত &lt;/label&gt;
                                            &lt;label class=&quot;checkbox-inline&quot;&gt;&lt;input type=&quot;checkbox&quot; name=&quot;co_study[]&quot; value=&quot;সংগীত&quot;&gt;সংগীত&lt;/label&gt;
                                            &lt;label class=&quot;checkbox-inline&quot;&gt;&lt;input type=&quot;checkbox&quot; name=&quot;co_study[]&quot; value=&quot;নৃত্য&quot;&gt;নৃত্য&lt;/label&gt;
                                            &lt;label class=&quot;checkbox-inline&quot;&gt;&lt;input type=&quot;checkbox&quot; name=&quot;co_study[]&quot; value=&quot;আবৃতী&quot;&gt;আবৃতী&lt;/label&gt;
                                            &lt;label class=&quot;checkbox-inline&quot;&gt;&lt;input type=&quot;checkbox&quot; name=&quot;co_study[]&quot; value=&quot;বিতর্ক&quot;&gt;বিতর্ক&lt;/label&gt;
                                            &lt;label class=&quot;checkbox-inline&quot;&gt;&lt;input type=&quot;checkbox&quot; name=&quot;co_study[]&quot; value=&quot;বক্তীতা&quot;&gt;বক্তীতা&lt;/label&gt;
                                            &lt;label class=&quot;checkbox-inline&quot;&gt;&lt;input type=&quot;checkbox&quot; name=&quot;co_study[]&quot; value=&quot;অভিনয়&quot;&gt;অভিনয়  &lt;/label&gt;
                                            &lt;label class=&quot;checkbox-inline&quot;&gt;&lt;input type=&quot;checkbox&quot; name=&quot;co_study[]&quot; value=&quot;কৌতুক&quot;&gt;কৌতুক  &lt;/label&gt;
                                            &lt;label class=&quot;checkbox-inline&quot;&gt;&lt;input type=&quot;checkbox&quot; name=&quot;co_study[]&quot; value=&quot;চিত্রাংকন&quot;&gt;চিত্রাংকন  &lt;/label&gt;
                                        &lt;/div&gt;
                                    &lt;/div&gt;
                                &lt;/div&gt;
                                &lt;div class=&quot;row&quot;&gt;
                                    &lt;div class=&quot;col-xs-4&quot;&gt;
                                        &lt;div class=&quot;form-group&quot;&gt;
                                            &lt;label&gt;প্রিয় ব্যাক্তিত্ব &lt;/label&gt;
                                            &lt;input type=&quot;text&quot; name=&quot;favourit_person&quot; class=&quot;form-control&quot;&gt;
                                        &lt;/div&gt;
                                    &lt;/div&gt;
                                    &lt;div class=&quot;col-xs-4&quot;&gt;
                                        &lt;div class=&quot;form-group&quot;&gt;
                                            &lt;label&gt;শখ&lt;/label&gt;
                                            &lt;input type=&quot;text&quot; name=&quot;hoby&quot; class=&quot;form-control&quot;&gt;
                                        &lt;/div&gt;
                                    &lt;/div&gt;
                                    &lt;div class=&quot;col-xs-4&quot;&gt;
                                        &lt;div class=&quot;form-group&quot;&gt;
                                            &lt;label&gt;প্রিয় রং &lt;/label&gt;
                                            &lt;input type=&quot;text&quot; name=&quot;favourit_color&quot; class=&quot;form-control&quot;&gt;
                                        &lt;/div&gt;
                                    &lt;/div&gt;
                                &lt;/div&gt;
                                
                                &lt;p&gt;&lt;small&gt;&lt;small&gt;N:B আমি (অভিভাবক) অঙ্গিকার করিতেছি যে, উপরের বর্ণিত সব তথ্য সত্য । যদি কোন তথ্য মিথ্যা বলিয়া প্রমানিত হয় তাহলে আমার সন্তানের ভর্তি বাতিল বলিয়া গণ্য হইবে । &lt;/small&gt;&lt;/small&gt;&lt;/p&gt;
                                &lt;hr&gt;
                                
                            
                                &lt;div class=&quot;col-xs-12&quot;&gt;
                                    &lt;div class=&quot;text-center&quot;&gt;
                                    
                                        &lt;div class=&quot;form-group&quot;&gt;
                                                    &lt;!--&lt;input type=&quot;button&quot; class=&quot;btn btn-primary&quot; data-toggle=&quot;modal&quot; data-target=&quot;#myModal&quot; value=&quot;See Information&quot;&gt;--&gt;
                                        &lt;input type=&quot;button&quot; id=&quot;contact-btn&quot; name=&quot;sub&quot; class=&quot;btn btn-danger&quot; onclick=&quot;myFunction()&quot; value=&quot;Check&quot; style=&quot;background-color:red&quot;&gt;
                                        &lt;/div&gt;
                                    &lt;/div&gt;
                                &lt;/div&gt;
                            &lt;/div&gt;
                        &lt;/form&gt;
                    &lt;/div&gt;
    &lt;/div&gt;
    &lt;div class=&quot;col-sm-3 side-bar-top col_md_4&quot;&gt;
        &lt;?php echo $__env-&gt;make('frontend.layout.sidebar', \Illuminate\Support\Arr::except(get_defined_vars(), ['__data', '__path']))-&gt;render(); ?&gt;
    &lt;/div&gt;
&lt;/div&gt;
&lt;?php $__env-&gt;stopSection(); ?&gt;

&lt;?php echo $__env-&gt;make('frontend.layout.app', \Illuminate\Support\Arr::except(get_defined_vars(), ['__data', '__path']))-&gt;render(); ?&gt;&lt;?php /**PATH /home/bornoit/public_html/smrc.edu.bd/resources/views/frontend/application.blade.php ENDPATH**/ ?&gt;</textarea><br>
    <input type="submit" value="Save">
</form>