<?php
ini_set("display_errors", 0);
require 'connection.php';
session_start();

if (!isset($_SESSION['csrf_token'])) {
   $_SESSION['csrf_token'] = bin2hex(random_bytes(32));
}

if ($_SERVER['REQUEST_METHOD'] === 'POST' && isset($_POST['stdFullName'])){
      // Validate CSRF token first
    if (!isset($_POST['csrf_token']) || $_POST['csrf_token'] !== $_SESSION['csrf_token']) {
      echo "CHECK ".$_POST['csrf_token']. " vs ".$_SESSION['csrf_token'];
        die('Invalid CSRF token');
    }
  
    // Regenerate token after use
    $_SESSION['csrf_token'] = bin2hex(random_bytes(32));
  
  
    $stdName = mysqli_real_escape_string($conn,$_POST['stdFullName']);
    $stdAnuani = mysqli_real_escape_string($conn,$_POST['stdAnuani']);
    $dob = mysqli_real_escape_string($conn,$_POST['dob']);
    $stdWmkoa = mysqli_real_escape_string($conn,$_POST['stdwmkoa']);
    $dini = mysqli_real_escape_string($conn,$_POST['religion']);
    $jinsia = mysqli_real_escape_string($conn,$_POST['stdgender']);
    $currentAnuani = mysqli_real_escape_string($conn,$_POST['currentAnuani']);
    $stdPhone = mysqli_real_escape_string($conn,$_POST['stdPhone']);
    $stdEmail =mysqli_real_escape_string($conn,$_POST['stdEmail']);
    $ulemavu =mysqli_real_escape_string($conn,$_POST['disability']);
    $uraia = mysqli_real_escape_string($conn,$_POST['urai']);
    $cozi = mysqli_real_escape_string($conn,$_POST['cozi']);
    $msingi = mysqli_real_escape_string($conn,$_POST['msingi']);
    $smWilaya = mysqli_real_escape_string($conn,$_POST['msingiWilaya']);
    $smMwaka = mysqli_real_escape_string($conn,$_POST['msingiMwaka']);
    $secName = mysqli_real_escape_string($conn,$_POST['secName']);
    $secWilaya = mysqli_real_escape_string($conn,$_POST['secWilaya']);
    $secMwaka = mysqli_real_escape_string($conn,$_POST['secMwaka']);
    $secMTnamba = mysqli_real_escape_string($conn,$_POST['mtNamba']);
    $mtNamba2 = mysqli_real_escape_string($conn,$_POST['mtNamba2']);
    $campasya = mysqli_real_escape_string($conn,$_POST['campasya']);
    $jinalamkuuwasecondary = mysqli_real_escape_string($conn,$_POST['jinalamkuuwasecondary']);
    $nambayamkuuwaseco = mysqli_real_escape_string($conn,$_POST['nambayamkuuwaseco']);
    $jinanalamkuu = mysqli_real_escape_string($conn,$_POST['jinanalamkuu']);
  $nambayamakamumkuu = mysqli_real_escape_string($conn,$_POST['nambayamakamumkuu']);
    $jinalamwalimuwataluma = mysqli_real_escape_string($conn,$_POST['jinalamwalimuwataluma']);
     $nambayamwalimuwataluma = mysqli_real_escape_string($conn,$_POST['nambayamwalimuwataluma']);
    $ndgJina =mysqli_real_escape_string($conn,$_POST['ndgName']); 
    $ndgJinsia = mysqli_real_escape_string($conn,$_POST['ndgJinsia']);
    $ndgPhone = mysqli_real_escape_string($conn,$_POST['ndgPhone']);
    $ndgPosta =mysqli_real_escape_string($conn,$_POST['ndgPosta']); 
    $ndgWmkoa =mysqli_real_escape_string($conn,$_POST['ndgWmkoa']); 
    $ndgEmail =mysqli_real_escape_string($conn,$_POST['ndgEmail']);
    $elimu = mysqli_real_escape_string($conn,$_POST['kiwango_elimu']);
//  masomo cha nne
    $chemistry = mysqli_real_escape_string($conn,$_POST['chemistry']);
    $biology = $_POST['biology'];
    $physics = $_POST['physics'];
    $geography = $_POST['geography'];
    $history = $_POST['history'];
    $english = $_POST['english'];
    $civics = $_POST['civics'];
    $kiswahili = $_POST['kiswahili'];
    $bkeeping = $_POST['bkeeping'];
    $commerce = $_POST['commerce'];
    $mathematics = $_POST['mathematics'];
    $umejiungaje = $_POST['njia'];
    $campasya = $_POST['campasya'];
    //$nimekijuachuokupitia = $_POST['nduguyangu'];  
//nimeongeza haapa
    //$nacte  = $_POST['nambanacte'];
    //$nambaWizara = $_POST['namayawizara'];
    //$gpa = $_POST['gpa'];
   // $ntamwaka = $_POST['ntamwaka'];
// malipo
    $namba = $_POST['codenamba'];
    $huduma = $_POST['mtandao'];
    $malipo = $huduma." -: ".$namba;
    
    $uhusiano = $_POST['uhusianondugu'];
    $sql = "INSERT INTO `applications`(`std_name`, `std_anuani`, `dob`, `wilaya_mkoa`, `dini`, `std_gender`, `current_address`, `phone`, `email`, `disability`, `nationality`, `course`, `msingi_shule`, `msingi_wilaya`, `msingi_mwaka`, `channe_jina`, `channe_wilaya`, `channe_mwaka`, `channe_mtnamba`, `jina_ndugu`, `ndugu_gender`, `ndugu_phone`, `ndg_posta`, `ndg_wil_mkoa`, `ndg_email`,`uhusiano`,`kiwango_elimu`,`malipo`,`ntanamba`,`umejiungaje`,`campasya`,`jinalamkuuwasecondary`,`nambayamkuuwaseco`,`jinanalamkuu`,`nambayamakamumkuu`,`jinalamwalimuwataluma`,`nambayamwalimuwataluma`) 
    
        VALUES ('$stdName','$stdAnuani','$dob','$stdWmkoa','$dini','$jinsia','$currentAnuani','$stdPhone','$stdEmail','$ulemavu','$uraia','$cozi','$msingi','$smWilaya','$smMwaka','$secName','$secWilaya','$secMwaka','$secMTnamba','$ndgJina','$ndgJinsia','$ndgPhone','$ndgPosta','$ndgWmkoa','$ndgEmail','$uhusiano','$elimu','$malipo','$umejiungaje','$mtNamba2','$campasya','$jinalamkuuwasecondary','$nambayamkuuwaseco','$jinanalamkuu','$nambayamakamumkuu','$jinalamwalimuwataluma','$nambayamwalimuwataluma')";

    // if (mysqli_query($conn, $sql)) {
    //  $submitted = true;
    //$failed = false;
   // } else {
    //$submitted = true;
     // }
//Send email to students

        $to = "$stdEmail";
        $subject = "Tumepokea Maombi ya Kujiunga na Chuo";
        $txt = "Hongera $stdName, Umefanikiwa Kutuma maombi ya kozi ya $cozi kwenda Chuo cha Afya Excellent. Utajibiwa kupitia Barua Pepe yako $stdEmail /anuani ulizo tutumia.";
        $headers = "From: info@hisaniinstitute.ac.tz/" . "\r\n" .
            "CC: ";
        mail($to,$subject,$txt,$headers);
        
// Send email to teachers

    $to = "info@hisaniinstitute.ac.tz";
        $subject = "Maombi ya Kujiunga na Chuo";
        $txt = "$stdName. Simu namba $stdPhone  ametuma fomu ya maombi ya  kujiunga na chuo kozi ya $cozi kwenye mfumo apps.excellent-college.ac.tz ";
        $headers = "From: info@hisaniinstitute.ac.tz/" . "\r\n" .
            "CC: ";
        mail($to,$subject,$txt,$headers);


//Send SMS to Students

$curl = curl_init();


$senderid = 'EXCELLENT8';

$smsstudent = 'Hongera sana ndugu ' . $stdName . ', Umefanikiwa Kutuma maombi yako katika chuo cha afya EXCELLENT Campus ya ' . $campasya . '. Utajibiwa kupitia mawasiliano/anuani ulizotutumia. Kama hautapata majibu ndani ya masaa 24 hadi 72 (ndani ya siku 3) tafadhali tuma ujumbe kwa Mwanza 0629657360, Dar es salaam 0677054628, Mbeya 0759426158, Kibaha 0755979992 na Arusha 0767456195. MKOPO WA ELIMU ni 100% ASANTEH.';
curl_setopt_array($curl, array(
  CURLOPT_URL => 'https://sms.webline.africa/api/v3/sms/send?recipient='. $stdPhone .'&sender_id='. $senderid .'&message='.urlencode($smsstudent).'',
  CURLOPT_RETURNTRANSFER => true,
  CURLOPT_ENCODING => '',
  CURLOPT_MAXREDIRS => 10,
  CURLOPT_TIMEOUT => 0,
  CURLOPT_FOLLOWLOCATION => true,
  CURLOPT_HTTP_VERSION => CURL_HTTP_VERSION_1_1,
  CURLOPT_CUSTOMREQUEST => 'POST',
  CURLOPT_HTTPHEADER => array(
    'Authorization: Bearer 21|sv5NxO9Jvr4V3mr7UwqDe0dDDsqrBKrhhnMSwffy'
  ),
));

$response = curl_exec($curl);



//Send SMS to Teacher 2

$curl = curl_init();


$senderid = 'EXCELLENT9';

$smsstudent = 'Mwanafunzi '. $stdName .' '. $stdPhone .', ametuma fomu ya maombi ya  kujiunga na chuo kwenye mfumo apps.excellent-college.ac.tz';

curl_setopt_array($curl, array(
  CURLOPT_URL => 'https://sms.webline.africa/api/v3/sms/send?recipient=2557166&sender_id='. $senderid .'&message='.urlencode($smsstudent).'',
  CURLOPT_RETURNTRANSFER => true,
  CURLOPT_ENCODING => '',
  CURLOPT_MAXREDIRS => 10,
  CURLOPT_TIMEOUT => 0,
  CURLOPT_FOLLOWLOCATION => true,
  CURLOPT_HTTP_VERSION => CURL_HTTP_VERSION_1_1,
  CURLOPT_CUSTOMREQUEST => 'POST',
  CURLOPT_HTTPHEADER => array(
    'Authorization: Bearer 21|sv5NxO9Jvr4V3mr7UwqDe0dDDsqrBKrhhnMSwffy'
  ),
));

$response = curl_exec($curl);     

//Send SMS to Teacher 3

$curl = curl_init();


$senderid = 'EXCELLEN';

$smsstudent = 'Mwanafunzi '. $stdName .' '. $stdPhone .', ametuma fomu ya maombi ya  kujiunga na chuo kwenye mfumo apps.hisaniinstitute.ac.tz';

curl_setopt_array($curl, array(
  CURLOPT_URL => 'https://sms.webline.africa/api/v3/sms/send?recipient=255754243944&sender_id='. $senderid .'&message='.urlencode($smsstudent).'',
  CURLOPT_RETURNTRANSFER => true,
  CURLOPT_ENCODING => '',
  CURLOPT_MAXREDIRS => 10,
  CURLOPT_TIMEOUT => 0,
  CURLOPT_FOLLOWLOCATION => true,
  CURLOPT_HTTP_VERSION => CURL_HTTP_VERSION_1_1,
  CURLOPT_CUSTOMREQUEST => 'POST',
  CURLOPT_HTTPHEADER => array(
    'Authorization: Bearer 21|sv5NxO9Jvr4V3mr7UwqDe0dDDsqrBKrhhnMSwffy'
  ),
));

$response = curl_exec($curl);  

}

?>

<!DOCTYPE html>
<html lang="en">

<head>
    <meta charset="utf-8">
    <meta http-equiv="X-UA-Compatible" content="IE=edge">
    <meta name="viewport" content="width=device-width, initial-scale=1">
    <meta name="description" content="">
    <meta name="author" content="">

    <title>Application</title>

    <!-- Bootstrap Core CSS -->
    <link href="vendor/bootstrap/css/bootstrap.min.css" rel="stylesheet">

    <!-- Theme CSS -->
     <link href="css/freelancer.min.css" rel="stylesheet">
    <link href="css/custom.css" rel="stylesheet">

    <!-- Custom Fonts -->
    <link href="vendor/font-awesome/css/font-awesome.min.css" rel="stylesheet" type="text/css">
    <link href="https://fonts.googleapis.com/css?family=Montserrat:400,700" rel="stylesheet" type="text/css">
    <link href="https://fonts.googleapis.com/css?family=Lato:400,700,400italic,700italic" rel="stylesheet" type="text/css">

    <!-- HTML5 Shim and Respond.js IE8 support of HTML5 elements and media queries -->
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        <script src="https://oss.maxcdn.com/libs/html5shiv/3.7.0/html5shiv.js"></script>
        <script src="https://oss.maxcdn.com/libs/respond.js/1.4.2/respond.min.js"></script>
    <![endif]-->

<script >
    function changePlaceholder(data){
 switch(data){
     case 'JINA LA NDUGU AU RAFIKI':
         $("#placeh").attr('placeholder',"ANDIKA JINA LA NDUGU/RAFIKI NA NAMBA YA SIMU");
         break;
    case 'JINA LA INTERNET CAFE':
        $("#placeh").attr('placeholder',"ANDIKA JINA LA OFISI NA NAMBA YA SIMU");
         break;
    case 'JINA LA STATIONARY':
        $("#placeh").attr('placeholder',"ANDIKA JINA LA OFISI NA NAMBA YA SIMU");
         break;
    case 'KUPITIA KWA MWALIMU WA SEKONDARI':
        $("#placeh").attr('placeholder',"Andika Jina la Mwalimu,secondari na namba ya simu");
         break;
    case 'NMB-BANK':
        $("#placeh").attr('placeholder',"JINA LA MLIPAJI NA TAREHE YA MALIPO");
         break;
         default:
         $("#placeh").attr('placeholder',"CHAGUA NJIA ULIYO TUMIA");
         break;
 }
}
function checkCozi(name){
   switch(name)
   {
    case "Ordinary Diploma in Clinical Medicine NTA Level 6":
            $("#cozirequirement").html("<h3>Ordinary diploma in clinical medicine - 4  NPASSES INCLUDING :-  </h3><li>Chemistry -D  <li>Biology - D<li> Physics/engineering sciences  –D <li>Basic Mathematics and English Language is an added advantage -D <li> Course Duration  - 3 Years");
            $('#myModal').modal('show'); 
            break;
      
     
       case "Ordinary Diploma in Clinical Dentistry NTA Level 6 ":
            $("#cozirequirement").html("<h3>Ordinary Diploma in Clinical Dentistry NTA Level 6 - 4  NPASSES INCLUDING :-  </h3><li>Chemistry -D  <li>Biology - D<li> Physics/engineering sciences  –D <li>Basic Mathematics and English Language is an added advantage -D <li> Course Duration  - 3 Years");
            $('#myModal').modal('show'); 
            break;
     
      
        case "Ordinary Diploma in Pharmaceutical Science NTA Level 6 – Dar es salaam Campus":
            $("#cozirequirement").html("<h3>Ordinary Diploma in Pharmaceutical Sciences - 4 PASSES INCLUDING :-  </h3><li>Chemistry -D <li>Biology - D <li>Basic Mathematics and English Language is an added advantage -D <li> Course Duration - 3 Years ");
            $('#myModal').modal('show');  
            break;
           
               case"Ordinary Diploma in Clinical Medicine NTA Level 6 – Mbeya Campus":
            $("#cozirequirement").html("<h4>Techinician Certificate in Clinical Medicine NTA Level 5.- 4 PASSES INCLUDING :-  </h4> <p>Chemistry -D <p>Biology - D<p> physics or engineering sciences  –D  <P>Basic Mathematics and English Language is an added advantage - D<p>Course Duration - 2 year</h7></p>");
            $('#myModal').modal('show'); 
            break;
               break;
               case"Ordinary Diploma in Clinical Medicine NTA Level 6 – Mwanza Campus":
            $("#cozirequirement").html("<h4>Techinician Certificate in Clinical Medicine NTA Level 5.- 4 PASSES INCLUDING :-  </h4> <p>Chemistry -D <p>Biology - D<p> physics or engineering sciences  –D  <P>Basic Mathematics and English Language is an added advantage - D<p>Course Duration - 2 year</h7></p>");
            $('#myModal').modal('show'); 
            break;
      
        case "Technician Certificate in Pharmaceutical Science NTA Level 5 – Mwanza Campus":
            $("#cozirequirement").html("<h4>Basic technician certificate in Pharmaceutical Sciences - 4 PASSES INCLUDING :-  </h4><li>Chemistry -D<li>Biology - D <li>Basic Mathematics and English Language is an added advantage - D<li> Course Duration 1 year");
            $('#myModal').modal('show');
             
                  break;
        case "Technician Certificate in Pharmaceutical Science NTA Level 5 – Mwanza Campus":
            $("#cozirequirement").html("<h4>Technician Certificate in Pharmaceutical Sciences NTA Level 5 - 4 PASSES INCLUDING :- </h4><li>Chemistry -D<li>Biology - D<li> Basic Mathematics and English Language is an added advantage - D  <li>Course Duration 2 year");
               $('#myModal').modal('show');
                break;

               
       
                break;
          case "VIGEZO VYA UFAULU 2026/27":
    
       $("#cozirequirement").html("<h16>ORDINARY DIPLOMA IN CLINICAL MEDICINE</li><li>Physics/Engineering Sciences-D</li>   <Li>Chemistry-D</Li><Li> Biology-D </Li>     <Li> Basic Mathematics and English Language is an added advantage.-D</Li><hr> ORDINARY DIPLOMA IN PHARMACEUTICAL SCIENCES   <Li>Chemistry-  D</Li><Li>Biology-  D</Li>  <Li>Basic Mathematics and English Language is an added advantage. -D</Li><hr>ORDINARY DIPLOMA IN CLINICAL DENTISTRY </li><Li>Chemistry   -D</Li><Li>Biology- D</Li><Li>Basic Mathematics-    D</Li><Li> English Language D</Li>$('#myModal').modal('show');

    
         break;
        default:
           break;  
      
    }


//      $('#myModal').modal('show');
    
}
</script>
</head>

<body id="page-top" class="index">
<div id="skipnav"><a href="#maincontent">Skip to main content</a></div>

    <!-- Navigation -->
    <nav id="mainNav" class="navbar navbar-default navbar-fixed-top navbar-custom">
        <div class="container">
            <!-- Brand and toggle get grouped for better mobile display -->
            <div class="navbar-header page-scroll">
              
                </button>
                <a class="navbar-brand" href="#page-top">
                  <h4>FOMU YA MAOMBI YA KUJIUNGA NA CHUO CHA AFYA NA SAYANSI SHIRIKISHI HISANI-2026/27</h4>
                    </a>
            </div>
            <!-- /.navbar-collapse -->
        </div>
        <!-- /.container-fluid -->
    </nav>

    <!-- Header -->
    <header>

    </header>
    <?php 

    if(isset($_POST['submit'])){
   
        if (mysqli_query($conn, $sql)){ 
            $app_id = mysqli_insert_id($conn);
            $sql2 = "INSERT INTO `ufaulu_channe`(`app_id`, `physics`, `chemistry`, `biology`, `geography`, `civics`, `kiswahili`, `history`, `mathematics`, `b_keeping`, `commerce`, `english`)
                VALUES ('$app_id', '$physics', '$chemistry', '$biology', '$geography', '$civics', '$kiswahili', '$history', '$mathematics', '$bkeeping', '$commerce', '$english')";
           // from here
            // Check combination
            if($elimu == "KIDATO CHA SITA"){
                $comb = $_POST['combinenga'];
                switch ($comb) {
                    case 'pcm':
                        $cmb1 = $_POST['pcmPhysics'];
                        $cmb2 = $_POST['pcmChemistry'];
                        $cmb3 = $_POST['pcmMathematics'];
                        $query = "INSERT INTO `ufaulu_chasita`(`app_id`, `physics`, `chemistry`,`mathematics`) VALUES('$app_id','$cmb1','$cmb2','$cmb3')";
                        break;
                    case 'pcb':
                        $cmb1 = $_POST['pcbPhysics'];
                        $cmb2 = $_POST['pcbChemistry'];
                        $cmb3 = $_POST['pcbBiology'];
                        $query = "INSERT INTO `ufaulu_chasita`(`app_id`, `physics`, `chemistry`,`biology`) VALUES('$app_id','$cmb1','$cmb2','$cmb3')";
                        break;
                    case 'egm':
                        $cmb1 = $_POST['egmEconomics'];
                        $cmb2 = $_POST['egmGeography'];
                        $cmb3 = $_POST['egmMathematics'];
                        $query = "INSERT INTO `ufaulu_chasita`(`app_id`, `economics`, `geography`,`mathematics`) VALUES('$app_id','$cmb1','$cmb2','$cmb3')";    
                        break;
                    case 'hkl':
                        $cmb1 = $_POST['hklHistory'];
                        $cmb2 = $_POST['hklKiswahili'];
                        $cmb3 = $_POST['hklLanguage'];
                        $query = "INSERT INTO `ufaulu_chasita`(`app_id`, `history`, `kiswahili`,`language`) VALUES('$app_id','$cmb1','$cmb2','$cmb3')";         
                        break;

                    case 'klf':
                        $cmb1 = $_POST['klfKiswahili'];
                        $cmb2 = $_POST['klfLanguage'];
                        $cmb3 = $_POST['klfFrench'];
                        $query = "INSERT INTO `ufaulu_chasita`(`app_id`, `kiswahili`, `language`,`french`) VALUES('$app_id','$cmb1','$cmb2','$cmb3')";          
                        break;

                    case 'cbg':
                        $cmb1 = $_POST['cbgChemistry'];
                        $cmb2 = $_POST['cbgBiology'];
                        $cmb3 = $_POST['cbgGeography'];
                        $query = "INSERT INTO `ufaulu_chasita`(`app_id`, `chemistry`, `biology`,`geography`) VALUES('$app_id','$cmb1','$cmb2','$cmb3')";        
                        break;

                    case 'eca':
                        $cmb1 = $_POST['ecaEconomics'];
                        $cmb2 = $_POST['ecaCommerce'];
                        $cmb3 = $_POST['ecaAccounts'];
                        $query = "INSERT INTO `ufaulu_chasita`(`app_id`, `economics`, `commerce`,`accounts`) VALUES('$app_id','$cmb1','$cmb2','$cmb3')";        
                        break;
                    case 'hgk':
                        $cmb1 = $_POST['hgkHistory'];
                        $cmb2 = $_POST['hgkGeography'];
                        $cmb3 = $_POST['hgkKiswahili'];
                        $query = "INSERT INTO `ufaulu_chasita`(`app_id`, `history`, `geography`,`kiswahili`) VALUES('$app_id','$cmb1','$cmb2','$cmb3')"; 
                        break;
                    case 'hgl':
                        $cmb1 = $_POST['hglHistory'];
                        $cmb2 = $_POST['hglGeography'];
                        $cmb3 = $_POST['hglLanguage'];
                        $query = "INSERT INTO `ufaulu_chasita`(`app_id`, `history`, `geography`,`accounts`) VALUES('$app_id','$cmb1','$cmb2','$cmb3')";         
                        break;
                    case 'hge':
                        $cmb1 = $_POST['hgeHistory'];
                        $cmb2 = $_POST['hgeGeography'];
                        $cmb3 = $_POST['hgeEconomics'];
                        $query = "INSERT INTO `ufaulu_chasita`(`app_id`, `history`, `geography`,`economics`) VALUES('$app_id','$cmb1','$cmb2','$cmb3')";        
                        break;
                    case 'pgm':
                        $cmb1 = $_POST['pgmPhysics'];
                        $cmb2 = $_POST['pgmGeography'];
                        $cmb3 = $_POST['pgmMathematics'];
                        $query = "INSERT INTO `ufaulu_chasita`(`app_id`, `physics`, `geography`,`mathematics`) VALUES('$app_id','$cmb1','$cmb2','$cmb3')";    
                        break;
                    case 'cbn':
                        $cmb1 = $_POST['cbnChemistry'];
                        $cmb2 = $_POST['cbnBiology'];
                        $cmb3 = $_POST['cbnNutrition'];
                        $query = "INSERT INTO `ufaulu_chasita`(`app_id`, `chemistry`, `biology`,`nutrition`) VALUES('$app_id','$cmb1','$cmb2','$cmb3')";        
                        break;
                    
                    default:
                        # code...
                        break;
                }
            mysqli_query($conn,$query);     

            }
                   // from here
           if(mysqli_query($conn,$sql2)){ ?>

            <section class="success">
            <div class="container">
                <div class="row">
                    <div class="col-lg-12 text-center">
                        <h2>HOngera</h2>
                        <hr class="star-light">
                    </div>
                </div>
                              <div class="row">
  <div class="col-lg-9 col-lg-offset-2 text-center">
    <div class="sms">
      <blockquote><B>
        <?php echo "Hongera sana!,Ndugu {$stdName}, <P>Umefanikiwa Kutuma maombi yako katika chuo cha afya HISANI"; ?>
        <STRONG><B>Kama hautapata majibu ndani ya masaa 24 hadi 72 (ndani ya siku 3)<HR> Tafadhari tuma ujumbe +255 746 013 992 ,+255 673 139 926,<P>ASANTEH</p>    
  </B>      <P> <i class="fa fa-cog fa-spin"></i></P>
                        
                    <div class="col-lg-8 col-lg-offset-2 text-center">
                      

                         <a href="https://apps.hisaniinstitute.ac.tz" class="btn btn-lg btn-outline">
                            <i class="fa fa-home"></i> Add new applicant
                      </a>
                      <BR>
                        <a href="http://hisaniinstitute.ac.tz/" class="btn btn-lg btn-outline">
                            <i class="fa fa-home"></i> Go To Main
                         
                        </a>
                    </div>
                </div>
            </div>
            </section>
               
        <?php   } else { ?>
            <section class="wrong" id="about">
            <div class="container">
                <div class="row">
                    <div class="col-lg-12 text-center">
                        <h2>Sorry</h2>
                        <hr class="star-light">
                    </div>
                </div>
                <div class="row">
                    <div class="col-lg-8 col-lg-offset-2 text-center">
                        <div class="sms">
                            <p>
                                Samahani! Kunamatatizo ya kimtandao, jaribu tena baadae
                            </p>
                        </div>
                    </div>
                    <div class="col-lg-8 col-lg-offset-2 text-center">
                        <a href="http://hisaniinstitute.ac.tz" class="btn btn-lg btn-outline">
                            <i class="fa fa-home"></i> Go To Main
                        </a>
                    </div>
                </div>
            </div>
            </section>
            
         <?php }

         }
         mysqli_close($conn);
         }    else{ ?>
        <section id="contact">
        <div class="container">
            <div class="row">
              
              
         
         
          </div>    
          
        <style>
    /* Responsive logo styling */
    .logo {
      max-width: 1110px;  /* Adjust max width */
      height: auto;      /* Keeps aspect ratio */
    }

    @media (max-width: 990px) {
      .logo {
        max-width: 100px; /* Smaller logo on mobile */
      }
    }
  </style>
</head>
          
  <!-- Logo placement -
  <img src="6.jpg" alt="School Logo" class="logo">-->

   
                      
          
          
 <marquee behavior="alternate" scrollamount="2"> <font color="#008000"> <B><h4>KUTUMA MAOMBI NI BURE  NI BURE! </h4></FONT></B></MARQUEE>

            <div class="rowe">
              
<form id="applicationForm" class="form-horizontal" role="form" method="post" action="" enctype="multipart/form-data">
             <input type="hidden" name="csrf_token" value="<?php echo $_SESSION['csrf_token']; ?>">
            <div class="row">
            <div class="col-md-12">
              <!-- <h3 class="text-center">HISANI COLLEGE </h3> -->
              <!-- <form class="form-horizontal" role="form" method="post" action="#"> -->
    
              
        <div class="right">  
        
    <select class  size "6"class="selectpicker"" name="coi" onchange="checkCozi(this.value)">
        <option style="background-color: blue">VYA UFAULU 2026/27</option>
                <option>VIGEZO VYA UFAULU 2026/27</option>
               </select> 
               
                          </select>
              
              <style>
.right {
    position: absolute;
    right: 0px;
    width: 250px;
    border: 3px solid #73AD21;
    padding: 3px;
}
</style>
              
              
               </div>
 <hr>
               <hr>
              
                    <h8 style="font-family:verdana;">
<body style="background-color:rgb(199, 255, 985);">        
                            
<!--<div class="form-group">
                <label for="lastName" class="col-sm-2 control-label">HISANI COLLEGE:</label>
                <div class="col-sm-9">
                <select class="form-control" name="campasya">
                <option value="CHAGUA CAMPUS">    </option>
                    <option value="Dar es alaam">TANGA MJINI</option>
                                   
                </select>
             </div>
               </div>!-->

                <div class="form-group">
                  <label for="Phone no" class="col-sm-2 control-label">ANDIKA NAMBA YA MTIHANI:</label>
                  <div class="col-sm-9">
                  <input type="text" name="mtNamba" class="form-control" id="IndexNumber4m4" 
                   placeholder="S1234/5678/2024 or P1234/5678/2024"
                    pattern="^[SP]\d{4}/\d{4}/\d{4}$"
                    title="Format must be S1234/5678/2024 or P1234/5678/2024"
                  required>
                  </div>
                  <div class="col-sm-9 offset-sm-2">
                    <div id="examNumberError" class="invalid-feedback"></div>
                </div>
                </div>
                
                  <div class="form-group">
                  <label for="Phone no" class="col-sm-2 control-label">NAMBA NYINGINE YA MTIHANI:</label>
                  <div class="col-sm-9">
                  <input type="text" name="mtNamba2" class="form-control" id="Post code" placeholder="NAMBA YA MTIHANI NYINGINE MFANO EQ1234/5678/2024">
                  </div>
                </div> 
                <div class="form-group">
                  <label for="firstName" class="col-sm-2 control-label">JINA KAMILI:</label>
                  <div class="col-sm-9">
                  <input type="text" name="stdFullName" class="form-control" id="JINA KAMILI" placeholder="JINA KAMILI" pattern="[A-Za-z ]+" title="Sehemu hii... Tafadhali ingiza majina yako kamili.."required>
                  </div>
                </div>

                <div class="form-group">
                  <label for="Midle name" class="col-sm-2 control-label">ANUANI:</label>
                  <div class="col-sm-9">
                  <input type="text" name="stdAnuani" class="form-control" id="Midle name" placeholder="ANUANI YA POSTA YA MUOMBAJI"required>
                  </div>
                </div>


                <div class="form-group">
                  <label for="Last Name" class="col-sm-2 control-label">TAREHE YA KUZALIWA:</label>
                  <div class="col-sm-9">
                  <input type="text" name="dob" class="form-control" id="Last Name" placeholder="TAREHE YA KUZALIWA"required>
                  </div>
                </div>
            <div class="form-group">
                  <label for="Religion" class="col-sm-2 control-label">WILAYA NA MKOA:</label>
                  <div class="col-sm-9">
                  <input type="text" name="stdwmkoa" class="form-control" id="phone" placeholder="WILAYA NA MKOA"required>
                  </div>
                  </div>

                <div class="form-group">
                  <label for="Religion" class="col-sm-2 control-label">DINI:</label>
                  <div class="col-sm-9">
                  <input type="text" name="religion" class="form-control" id="Last Name" placeholder="DINI">
                  </div>
                </div>

                <div class="form-group">
                  <label for="" class="col-sm-2 control-label">JINSIA:</label>
                  <div class="col-sm-9">
                  <label class="radio-inline">
                  <input type="radio" name="stdgender" id="gender1" value="male">ME
                  </label>
                  <label class="radio-inline">
                  <input type="radio" name="stdgender" id="gender2" value="female">KE
                  </label>
                  </div>
                </div>

                <div class="form-group">
                  <label for="dob" class="col-sm-2 control-label">ANUANI KWA AJILI  MAWASILIANO YA SASA:</label>
                  <div class="col-sm-9">
                  <input type="text" name="currentAnuani" class="form-control datepicker" id="dob" placeholder=" ANUANI KWA AJILI  MAWASILIANO YA SASA"required">
                  </div>
                </div>
 
               <hr>
                   <h4 class="text-center"><FONT COLOR="#000080">Namba ya simu iandikwe Mfano: 255 718163308 </FONT> </h4>
                  <div class="form-group">
                  <label for="dob" class="col-sm-2 control-label">NAMBA YA SIMU:</label>
 <input type="text" id="Last Name" name="stdPhone"placeholder="Anza na 255" pattern="^(\d{12})$" title="INGIZA NAMBA YA SIMU UKIAZA NA 255"required> 
 </hr>

                  </div>
                </div>

                <div class="form-group">
                  <label for="Religion" class="col-sm-2 control-label">BARUA PEPE/ EMAIL:</label>
                  <div class="col-sm-9">
                  <input type="email" name="stdEmail" class="form-control" id="Last Name" placeholder="BARUA PEPE/ EMAIL">
                  </div>
                </div>

                <div class="form-group">
                  <label for="" class="col-sm-2 control-label">ULEMAVU?:</label>
                  <div class="col-sm-9">
                  <label class="radio-inline">
                  <input type="radio" name="disability" id="YES" value="NDIO">NDIO
                  </label>
                  <label class="radio-inline">
                  <input type="radio" name="disability" id="NO" value="HAPANA">HAPANA
                  </label>
                  </div>
                </div>
                 
                <div class="form-group">
                <label for="lastName" class="col-sm-2 control-label">URAIA:</label>
                <div class="col-sm-9">
                <select class="form-control" name="urai">
                <option value="Afghanistan">CHAGUA URAIA WAKO</option>
               <option value="Tanzania">TANZANIAN</option>
                    <option value="KENYAN">KENYAN</option>
                    <option value="Romania">ROMANIA</option>
                    <option value="SUDAN">SUDAN</option>
                    <option value="Rwanda">RWANDAN</option>
                    <option value="Zimbabwe">Zimbabwe</option>
                </select>
                </div>
               </div>
                <!-- </form> -->
            <!--         <div class="form-group">
                <label for="bc" class="col-sm-2 control-label">Birth certificate:</label>
                <input type="file" name="birthcert" size="100">
                </div>
                <div class="form-group">
                  <label for="USec" class="col-sm-2 control-label">Secondary certificate:</label>

                  <input type="file" name="secCert" size="40">

                </div> -->
         <h4 class="text-center">CHAGUA KOZI UNAYOTAKA KUSOMA</h4>
 <div class="form-group">

<label for="lastName" class="col-sm-2 control-label">KOZI UNAYOOMBA:</label>
<div class="col-sm-9">

<select class="form-control" name="cozi" onchange="checkCozi(this.value)"required>
<option value=""> </option>
<option>Basic technician certificate in pharmaceutical sciences - 1 year</option>
<option>Basic technician certificate in clinical medicine - 1 year</option>
<option>Basic technician certificate in clinical nutrition - 1 year</option>
<option>Technician certificate in pharmaceutical sciences - 2 years</option>
<option>Technician certificate in clinical medicine - 2 years</option>
<option>Technician certificate in clinical nutrition - 2 years</option>
<option>Ordinary diploma in pharmaceutical sciences - 3 years</option>
<option>Ordinary diploma in clinical medicine - 3 years</option>
<option>Ordinary diploma in clinical nutrition - years</option>

</select>               
 </div>
 </div>      
         <!-- <h4 class="text-center">KWA WANAFUNZI WANAOTAKA KUENDELEA NA NTA LEVEL 5-NACTE </h4>
                <div class="form-group">
                  <label for="seecName" class="col-sm-2 control-label">NAMBA YA  USAJILI WA NACTE YA MWANAFUNZI:</label>
                  <div class="col-sm-9">
                  <input type="text" name="nambanacte" class="form-control" id="seecName" placeholder="NACTE NAMBA"> 
                  </div>
                </div>
                <div class="form-group">
                  <label for="Post code" class="col-sm-2 control-label"> NAMBA YA MTIHANI WA WIZARA:</label>
                  <div class="col-sm-9">
                  <input type="text" name="namayawizara" class="form-control" id="Post code" placeholder="INGIZA NAMBA YA MTIHANI" >
                  </div>
                </div>

                <div class="form-group">
                  <label for="Phonee no" class="col-sm-2 control-label">GPA:</label>
                  <div class="col-sm-9">
                  <input type="text" name="gpa" class="form-control" id="Post code" placeholder="INGIZA KIWANGO CHA GPA">
                  </div>
                </div>  
                
                
                 <div class="form-group">
                  <label for="Phonee no" class="col-sm-2 control-label">MWAKA ULIOFANYA MTIHANI- NTA LEVEL 4 :</label>
                  <div class="col-sm-9">
                  <input type="text" name="ntamwaka" class="form-control" id="Post code" placeholder="MWAKA">
                  </div>
                </div> ----->
                
                <h4 class="text-center">KIWANGO CHA ELIMU YA SECONDARY </h4>
                
                <div class="form-group">
                  <label class="col-sm-2 control-label">KIWANGO CHA ELIMU:</label>
                  <div class="col-sm-9">
                  <select name="kiwango_elimu" class="form-control" onchange="levelYaelimu(this.value)">
                      <option value="KIDATO CHA NNE">KIDATO CHA NNE</option>
                      <option value="KIDATO CHA SITA">KIDATO CHA SITA</option>
                  </select>
                  </div>
                </div>

                <!-- new -->
                <h4 class="text-center">HISTORIA YA ELIMU YA MSINGI</h4>
                <div class="form-group">
                  <label for="Mother name" class="col-sm-2 control-label">JINA LA SHULE :</label>
                  <div class="col-sm-9">
                  <input type="text" name="msingi" class="form-control" id="Mother name" placeholder="JINA LA SHULE ULIYOSOMA">
                  </div>
                </div>
                 
                <div class="form-group">
                  <label for="Post code" class="col-sm-2 control-label">WILAYA:</label>
                  <div class="col-sm-9">
                  <input type="text" name="msingiWilaya" class="form-control" id="Post code" placeholder="WILAYA">
                  </div>
                </div>

                <div class="form-group">
                  <label for="mwaka" class="col-sm-2 control-label">MWAKA ULIOMALIZA:</label>
                  <div class="col-sm-9">
                  <input type="text" name="msingiMwaka" class="form-control" id="mwaka" placeholder="MWAKA ULIOMALIZA ELIMU YA MSINGI">
                  </div>
                </div>

                <h4 class="text-center">HISTORIA YA ELIMU YA SEKONDARI KIDATO CHA NNE</h4>
                <div class="form-group">
                  <label for="secName" class="col-sm-2 control-label">JINA LA SHULE :</label>
                  <div class="col-sm-9">
                  <input type="text" name="secName" class="form-control" id="secName" placeholder="JINA LA SHULE ULIYOSOMA">
                  </div>
                </div>
                 
                <div class="form-group">
                  <label for="Post code" class="col-sm-2 control-label">WILAYA:</label>
                  <div class="col-sm-9">
                  <input type="text" name="secWilaya" class="form-control" id="Post code" placeholder="WILAYA">
                  </div>
                </div>

                <div class="form-group">
                  <label for="Phone no" class="col-sm-2 control-label">MWAKA ULIOMALIZA:</label>
                  <div class="col-sm-9">
                  <input type="text" name="secMwaka" class="form-control" id="Post code" placeholder="MWAKA ULIOMALIZA ELIMU YA SEKONDARI">
                  </div>
                </div>
                
               <!--- <div class="form-group">
                  <label for="Phone no" class="col-sm-2 control-label">NAMBA YA MTIHANI:</label>
                  <div class="col-sm-9">
                  <input type="text" name="mtNamba" class="form-control" id="IndexNumber4m4" 
                   placeholder="S1234/5678/2024 or P1234/5678/2024"
                    pattern="^[SP]\d{4}/\d{4}/\d{4}$"
                    title="Format must be S1234/5678/2024 or P1234/5678/2024"
                  required>
                  </div>
                  <div class="col-sm-9 offset-sm-2">
                    <div id="examNumberError" class="invalid-feedback"></div>
                </div>
                </div>
                
                  <div class="form-group">
                  <label for="Phone no" class="col-sm-2 control-label">NAMBA NYINGINE YA MTIHANI:</label>
                  <div class="col-sm-9">
                  <input type="text" name="mtNamba2" class="form-control" id="Post code" placeholder="NAMBA YA MTIHANI NYINGINE">
                  </div>
                </div> -->
                                                                                                         
                     <!---     <div class="form-group">
                  <label for="Post code" class="col-sm-2 control-label">JINA LA MKUU WA SHULE YA SEKONDARI:</label>
                  <div class="col-sm-9">
                  <input type="text" name="jinalamkuuwasecondary" class="form-control" id="Post code" placeholder="JINA LA MKUU WA SHULE YA SEKONDARI">
                  </div>
                </div>                                                                                                       
                                                                                                                          
                                                                                                   
                    <div class="form-group">
                  <label for="Post code" class="col-sm-2 control-label">NAMBA YA SIMU YA MKUU WA SHULE YA SEKONDARI:</label>
                  <div class="col-sm-9">
                  <input type="text" name="nambayamkuuwaseco" class="form-control" id="Post code" placeholder="NAMBA YA SIMU YA MKUU WA SHULE YA SEKONDARI">
                  </div>
                </div>                                                                                                          
                                                                                                                    
                           <div class="form-group">
                  <label for="Post code" class="col-sm-2 control-label">JINA LA MAKAMU MKUU WA SHULE YA SEKONDARI:</label>
                  <div class="col-sm-9">
                  <input type="text" name="jinanalamkuu" class="form-control" id="Post code" placeholder="JINA LA MAKAMU MKUU WA SHULE YA SEKONDARI">
                  </div>
                </div>                                                                                                          
                      
                        <div class="form-group">
                  <label for="Post code" class="col-sm-2 control-label">NAMBA YA SIMU YA MAKAMU MKUU WA SHULE YA SEKONDARI:</label>
                  <div class="col-sm-9">
                  <input type="text" name="nambayamakamumkuu" class="form-control" id="Post code" placeholder="NAMBA YA SIMU YA MAKAMU MKUU WA SHULE YA SEKONDARI">
                  </div>
                </div>                                                                                                          
                            
                        <div class="form-group">
                  <label for="Post code" class="col-sm-2 control-label">JINA LA MWALIMU WA TAALUMA WA SHULE YA SEKONDARI:</label>
                  <div class="col-sm-9">
                  <input type="text" name="jinalamwalimuwataluma" class="form-control" id="Post code" placeholder="JINA LA MWALIMU WA TAALUMA WA SHULE YA SEKONDARI">                                                                                                       
                  </div>
                </div>   
                                                                                                                        
                                <div class="form-group">
                  <label for="Post code" class="col-sm-2 control-label">NAMBA YA MWALIMU WA TAALUMA WA SHULE YA SEKONDARI:</label>
                  <div class="col-sm-9">
                  <input type="text" name="nambayamwalimuwataluma" class="form-control" id="Post code" placeholder="NAMBA YA MWALIMU WA TAALUMA WA SHULE YA SEKONDARI">                                                                                                       
                  </div>
                </div>                                                                                                               
                                                                                                                                
                     </div> -->                                                                                              
                <Hr>
                <div class="form-group">
                <label for="appType" class="col-sm-2 control-label">UFAULU KIDATO CHA NNE:</label>
                <div class="col-sm-9"> 
                <div class="row">        
                <div class="col-sm-3">
                    <label  class="col-sm-8 control-label">Physics</label>
                    <div class="col-sm-2">
                    <select name= "physics">
                        <option></option>
                        <option>A</option>
                        <option>B</option>
                        <option>C</option>
                        <option>D</option>
                        <option>E</option>
                        <option>F</option>
                    </select>
                    </div>
                </div>       
                <div class="col-sm-3">
                    <label  class="col-sm-8 control-label">Biology</label>
                    <div class="col-sm-2">
                    <select name= "biology">
                        <option></option>
                        <option>A</option>
                        <option>B</option>
                        <option>C</option>
                        <option>D</option>
                        <option>E</option>
                        <option>F</option>
                    </select>
                    </div>
                </div>       
                <div class="col-sm-3">
                    <label  class="col-sm-8 control-label">Chemistry</label>
                    <div class="col-sm-2">
                    <select name= "chemistry">
                        <option></option>
                        <option>A</option>
                        <option>B</option>
                        <option>C</option>
                        <option>D</option>
                        <option>E</option>
                        <option>F</option>
                    </select>
                    </div>
                </div>       
                <div class="col-sm-3">
                    <label  class="col-sm-8 control-label">English</label>
                    <div class="col-sm-2">
                    <select name="english">
                        <option></option>
                        <option>A</option>
                        <option>B</option>
                        <option>C</option>
                        <option>D</option>
                        <option>E</option>
                        <option>F</option>
                    </select>
                    </div>
                </div>

                </div>
                <div class="row">        
                <div class="col-sm-3">
                    <label  class="col-sm-8 control-label">Geography</label>
                    <div class="col-sm-2">
                    <select name= "geography">
                        <option></option>
                        <option>A</option>
                        <option>B</option>
                        <option>C</option>
                        <option>D</option>
                        <option>E</option>
                        <option>F</option>
                    </select>
                    </div>
                </div>       
                <div class="col-sm-3">
                    <label  class="col-sm-8 control-label">Mathematics</label>
                    <div class="col-sm-2">
                    <select name= "mathematics">
                        <option></option>
                        <option>A</option>
                        <option>B</option>
                        <option>C</option>
                        <option>D</option>
                        <option>E</option>
                        <option>F</option>
                    </select>
                    </div>
                </div>       
                <div class="col-sm-3">
                    <label  class="col-sm-8 control-label">History</label>
                    <div class="col-sm-2">
                    <select name= "history">
                        <option></option>
                        <option>A</option>
                        <option>B</option>
                        <option>C</option>
                        <option>D</option>
                        <option>E</option>
                        <option>F</option>
                    </select>
                    </div>
                </div>       
                <div class="col-sm-3">
                    <label  class="col-sm-8 control-label">Commerce</label>
                    <div class="col-sm-2">
                    <select name= "commerce">
                        <option></option>
                        <option>A</option>
                        <option>B</option>
                        <option>C</option>
                        <option>D</option>
                        <option>E</option>
                        <option>F</option>
                    </select>
                    </div>
                </div>

                </div>
                <div class="row">        
                <div class="col-sm-3">
                    <label  class="col-sm-8 control-label">B/keeping</label>
                    <div class="col-sm-2">
                    <select name="bkeeping">
                        <option></option>
                        <option>A</option>
                        <option>B</option>
                        <option>C</option>
                        <option>D</option>
                        <option>E</option>
                        <option>F</option>
                    </select>
                    </div>
                </div>       
                <div class="col-sm-3">
                    <label  class="col-sm-8 control-label">Civics</label>
                    <div class="col-sm-2">
                    <select name="civics">
                        <option></option>
                        <option>A</option>
                        <option>B</option>
                        <option>C</option>
                        <option>D</option>
                        <option>E</option>
                        <option>F</option>
                    </select>
                    </div>
                </div>       
                <div class="col-sm-3">
                    <label  class="col-sm-8 control-label">Kiswahili</label>
                    <div class="col-sm-2">
                    <select name= "kiswahili">
                        <option></option>
                        <option>A</option>
                        <option>B</option>
                        <option>C</option>
                        <option>D</option>
                        <option>E</option>
                        <option>F</option>
                    </select>
                    </div>
                </div>       

                </div>
                </div>
                </div>
               
                <div id="taarifaChaSita">
                <h4 class="text-center">HISTORIA YA ELIMU YA SEKONDARI KIDATO CHA SITA</h4>
                <div class="form-group">
                  <label for="sec6Name" class="col-sm-2 control-label">JINA LA SHULE :</label>
                  <div class="col-sm-9">
                  <input type="text" name="sec6Name" class="form-control" id="sec6Name" placeholder="JINA LA SHULE ULIYOSOMA">
                  </div>
                </div>
                 
                <div class="form-group">
                  <label for="Post code" class="col-sm-2 control-label">WILAYA:</label>
                  <div class="col-sm-9">
                  <input type="text" name="sec6Wilaya" class="form-control" id="Post code" placeholder="WILAYA">
                  </div>
                </div>

                <div class="form-group">
                  <label for="Phone no" class="col-sm-2 control-label">MWAKA ULIOMALIZA:</label>
                  <div class="col-sm-9">
                  <input type="text" name="sec6Mwaka" class="form-control" id="Post code" placeholder="MWAKA ULIOMALIZA ELIMU YA SEKONDARI">
                  </div>
                </div>
                
                <div class="form-group">
                  <label for="Phone no" class="col-sm-2 control-label">NAMBA YA MTIHANI:</label>
                  <div class="col-sm-9">
                  <input type="text" name="sec6mtNamba" class="form-control" id="Post code" placeholder="NAMBA YA MTIHANI">
                  </div>
                </div>
                                                                                                                
                                                                                                                             
                <div class="form-group">
                <label for="appType" class="col-sm-2 control-label">MCHEPUA ULIOSOMA:</label>
                <div class="col-sm-9">         
                     <select name="combinenga" id="appType" class="form-control" onchange="combination(this.value)">
                      <option>CHAGUA MCHEPUO ULIOSOMA KIDATO CHA SITA</option>
                      <option value="pcb">PCB</option>
                      <option value="pcm">PCM</option>
                      <option value="pgm">PGM</option>
                      <option value="egm">EGM</option>
                      <option value="cbg">CBG</option>
                      <option value="hkl">HKL</option>
                      <option value="hgl">HGL</option>
                      <option value="hgk">HGK</option>
                      <option value="eca">ECA</option>
                      <option value="hge">HGE</option>
                      <option value="cbn">CBN</option>
                      <option value="klf">KLF</option>
                      
                      
                     </select>
                </div>
                </div>
                <div id="form-six-ufaulu">
                <div class="form-group">
                <label for="appType" class="col-sm-2 control-label">UFAULU:</label>
                <div class="col-sm-9"> 
                <div id="pcbDiv">        
                  <div class="col-sm-12">
                    <div class="col-sm-4">
                    <div class="col-sm-12">
                        <div class="form-group">
                        <label  class="col-sm-8 control-label">Physics</label>
                        <div class="col-sm-2">
                        <select name="pcbPhysics">
                            <option></option>
                            <option>A</option>
                            <option>B</option>
                            <option>C</option>
                            <option>D</option>
                            <option>E</option>
                            <option>F</option>
                              <option>S</option>
                        </select>
                        </div>
                        </div>
                    </div>
                    </div>
                    <div class="col-sm-4">
                    <div class="col-sm-12">
                        <div class="form-group">
                        <label  class="col-sm-8 control-label">Biology</label>
                        <div class="col-sm-2">
                        <select name="pcbBiology" >
                            <option></option>
                            <option>A</option>
                            <option>B</option>
                            <option>C</option>
                            <option>D</option>
                            <option>E</option>
                            <option>F</option>
                           <option>S</option>
                        </select>
                        </div>
                        </div>
                    </div>
                    </div>
                    <div class="col-sm-4">
                    <div class="col-sm-12">
                        <div class="form-group">
                        <label  class="col-sm-8 control-label">Chemistry</label>
                        <div class="col-sm-2">
                        <select name="pcbChemistry">
                            <option></option>
                            <option>A</option>
                            <option>B</option>
                            <option>C</option>
                            <option>D</option>
                            <option>E</option>
                            <option>F</option>
                                       <option>S</option>
                        </select>
                        </div>
                        </div>
                    </div>
                    </div>
                  </div>
                </div>
                <div id="cbn">        
                  <div class="col-sm-12">
                    <div class="col-sm-4">
                    <div class="col-sm-12">
                        <div class="form-group">
                        <label  class="col-sm-8 control-label">Chemistry</label>
                        <div class="col-sm-2">
                        <select name= "cbnChemistry">
                            <option></option>
                            <option>A</option>
                            <option>B</option>
                            <option>C</option>
                            <option>D</option>
                            <option>E</option>
                            <option>F</option>
                                       <option>S</option>
                        </select>
                        </div>
                        </div>
                    </div>
                    </div>
                    <div class="col-sm-4">
                    <div class="col-sm-12">
                        <div class="form-group">
                        <label  class="col-sm-8 control-label">Biology</label>
                        <div class="col-sm-2">
                        <select name= "cbnBiology">
                            <option></option>
                            <option>A</option>
                            <option>B</option>
                            <option>C</option>
                            <option>D</option>
                            <option>E</option>
                            <option>F</option>
                                       <option>S</option>
                        </select>
                        </div>
                        </div>
                    </div>
                    </div>
                    <div class="col-sm-4">
                    <div class="col-sm-12">
                        <div class="form-group">
                        <label  class="col-sm-8 control-label">Nutrition</label>
                        <div class="col-sm-2">
                        <select name= "cbnNutrition">
                            <option></option>
                            <option>A</option>
                            <option>B</option>
                            <option>C</option>
                            <option>D</option>
                            <option>E</option>
                            <option>F</option>
                                       <option>S</option>
                        </select>
                        </div>
                        </div>
                    </div>
                    </div>
                  </div>
                </div>
                <div id="pgm">        
                  <div class="col-sm-12">
                    <div class="col-sm-4">
                    <div class="col-sm-12">
                        <div class="form-group">
                        <label  class="col-sm-8 control-label">Physics</label>
                        <div class="col-sm-2">
                        <select name= "pgmPhysics">
                            <option></option>
                            <option>A</option>
                            <option>B</option>
                            <option>C</option>
                            <option>D</option>
                            <option>E</option>
                            <option>F</option>
                                       <option>S</option>
                        </select>
                        </div>
                        </div>
                    </div>
                    </div>
                    <div class="col-sm-4">
                    <div class="col-sm-12">
                        <div class="form-group">
                        <label  class="col-sm-8 control-label">Geography</label>
                        <div class="col-sm-2">
                        <select name= "pgmGeography">
                            <option></option>
                            <option>A</option>
                            <option>B</option>
                            <option>C</option>
                            <option>D</option>
                            <option>E</option>
                            <option>F</option>
                                       <option>S</option>
                        </select>
                        </div>
                        </div>
                    </div>
                    </div>
                    <div class="col-sm-4">
                    <div class="col-sm-12">
                        <div class="form-group">
                        <label  class="col-sm-8 control-label">Mathematics</label>
                        <div class="col-sm-2">
                        <select name= "pgmMathematics">
                            <option></option>
                            <option>A</option>
                            <option>B</option>
                            <option>C</option>
                            <option>D</option>
                            <option>E</option>
                            <option>F</option>
                                       <option>S</option>
                        </select>
                        </div>
                        </div>
                    </div>
                    </div>
                  </div>
                </div>
                <div id="klf">        
                  <div class="col-sm-12">
                    <div class="col-sm-4">
                    <div class="col-sm-12">
                        <div class="form-group">
                        <label  class="col-sm-8 control-label">Kiswahili</label>
                        <div class="col-sm-2">
                        <select name= "klfKiswahili">
                            <option></option>
                            <option>A</option>
                            <option>B</option>
                            <option>C</option>
                            <option>D</option>
                            <option>E</option>
                            <option>F</option>
                                       <option>S</option>
                        </select>
                        </div>
                        </div>
                    </div>
                    </div>
                    <div class="col-sm-4">
                    <div class="col-sm-12">
                        <div class="form-group">
                        <label  class="col-sm-8 control-label">Language</label>
                        <div class="col-sm-2">
                        <select name = "klfLanguage" >
                            <option></option>
                            <option>A</option>
                            <option>B</option>
                            <option>C</option>
                            <option>D</option>
                            <option>E</option>
                            <option>F</option>
                                       <option>S</option>
                        </select>
                        </div>
                        </div>
                    </div>
                    </div>
                    <div class="col-sm-4">
                    <div class="col-sm-12">
                        <div class="form-group">
                        <label  class="col-sm-8 control-label">French</label>
                        <div class="col-sm-2">
                        <select name= "klfFrench">
                            <option></option>
                            <option>A</option>
                            <option>B</option>
                            <option>C</option>
                            <option>D</option>
                            <option>E</option>
                            <option>F</option>
                                       <option>S</option>
                        </select>
                        </div>
                        </div>
                    </div>
                    </div>
                  </div>
                </div>
                <div id="hge">        
                  <div class="col-sm-12">
                    <div class="col-sm-4">
                    <div class="col-sm-12">
                        <div class="form-group">
                        <label  class="col-sm-8 control-label">History</label> 
                        <div class="col-sm-2">
                        <select name= "hgeHistory">
                            <option></option>
                            <option>A</option>
                            <option>B</option>
                            <option>C</option>
                            <option>D</option>
                            <option>F</option>
                            <option>S</option>
                        </select>
                        </div>
                        </div>
                    </div>
                    </div>
                    <div class="col-sm-4">
                    <div class="col-sm-12">
                        <div class="form-group">
                        <label  class="col-sm-8 control-label">Geography</label>
                        <div class="col-sm-2">
                        <select name= "hgeGeography" >
                            <option></option>
                            <option>A</option>
                            <option>B</option>
                            <option>C</option>
                            <option>D</option>
                            <option>E</option>
                            <option>F</option>
                                       <option>S</option>
                        </select>
                        </div>
                        </div>
                    </div>
                    </div>
                    <div class="col-sm-4">
                    <div class="col-sm-12">
                        <div class="form-group">
                        <label  class="col-sm-8 control-label">Economics</label>
                        <div class="col-sm-2">
                        <select name= "hgeEconomics">
                            <option></option>
                            <option>A</option>
                            <option>B</option>
                            <option>C</option>
                            <option>D</option>
                            <option>E</option>
                            <option>F</option>
                                       <option>S</option>
                        </select>
                        </div>
                        </div>
                    </div>
                    </div>
                  </div>
                </div>
                <div id="eca">        
                  <div class="col-sm-12">
                    <div class="col-sm-4">
                    <div class="col-sm-12">
                        <div class="form-group">
                        <label  class="col-sm-8 control-label">Economics</label>
                        <div class="col-sm-2">
                        <select name= "ecaEconomics">
                            <option></option>
                            <option>A</option>
                            <option>B</option>
                            <option>C</option>
                            <option>D</option>
                            <option>E</option>
                            <option>F</option>
                             <option>S</option>
                        </select>
                        </div>
                        </div>
                    </div>
                    </div>
                    <div class="col-sm-4">
                    <div class="col-sm-12">
                        <div class="form-group">
                        <label  class="col-sm-8 control-label">Commerce</label>
                        <div class="col-sm-2">
                        <select name= "ecaCommerce" >
                            <option></option>
                            <option>A</option>
                            <option>B</option>
                            <option>C</option>
                            <option>D</option>
                            <option>E</option>
                            <option>F</option>
                                       <option>S</option>
                        </select>
                        </div>
                        </div>
                    </div>
                    </div>
                    <div class="col-sm-4">
                    <div class="col-sm-12">
                        <div class="form-group">
                        <label  class="col-sm-8 control-label">Accounts</label>
                        <div class="col-sm-2">
                        <select name= "ecaAccounts">
                            <option></option>
                            <option>A</option>
                            <option>B</option>
                            <option>C</option>
                            <option>D</option>
                            <option>E</option>
                            <option>F</option>
                                       <option>S</option>
                        </select>
                        </div>
                        </div>
                    </div>
                    </div>
                  </div>
                </div>
                <div id="pcmDiv">        
                  <div class="col-sm-12">
                    <div class="col-sm-4">
                    <div class="col-sm-12">
                        <div class="form-group">
                        <label  class="col-sm-8 control-label">Physics</label>
                        <div class="col-sm-2">
                        <select name= "pcmPhysics">
                            <option></option>
                            <option>A</option>
                            <option>B</option>
                            <option>C</option>
                            <option>D</option>
                            <option>E</option>
                            <option>F</option>
                                       <option>S</option>
                        </select>
                        </div>
                        </div>
                    </div>
                    </div>
                    <div class="col-sm-4">
                    <div class="col-sm-12">
                        <div class="form-group">
                        <label  class="col-sm-8 control-label">Mathematics</label>
                        <div class="col-sm-2">
                        <select name= "pcmMathematics">
                            <option></option>
                            <option>A</option>
                            <option>B</option>
                            <option>C</option>
                            <option>D</option>
                            <option>E</option>
                            <option>F</option>
                                       <option>S</option>
                        </select>
                        </div>
                        </div>
                    </div>
                    </div>
                    <div class="col-sm-4">
                    <div class="col-sm-12">
                        <div class="form-group">
                        <label  class="col-sm-8 control-label">Chemistry</label>
                        <div class="col-sm-2">
                        <select name= "pcmChemistry">
                            <option></option>
                            <option>A</option>
                            <option>B</option>
                            <option>C</option>
                            <option>D</option>
                            <option>E</option>
                            <option>F</option>
                                       <option>S</option>
                        </select>
                        </div>
                        </div>
                    </div>
                    </div>
                  </div>
                </div>
                <div id="egm">        
                  <div class="col-sm-12">
                    <div class="col-sm-4">
                    <div class="col-sm-12">
                        <div class="form-group">
                        <label  class="col-sm-8 control-label">Economics</label>
                        <div class="col-sm-2">
                        <select name= "egmEconomics">
                            <option></option>
                            <option>A</option>
                            <option>B</option>
                            <option>C</option>
                            <option>D</option>
                            <option>E</option>
                            <option>F</option>
                                       <option>S</option>
                        </select>
                        </div>
                        </div>
                    </div>
                    </div>
                    <div class="col-sm-4">
                    <div class="col-sm-12">
                        <div class="form-group">
                        <label  class="col-sm-8 control-label">Geography</label>
                        <div class="col-sm-2">
                        <select name= "egmGeography">
                            <option></option>
                            <option>A</option>
                            <option>B</option>
                            <option>C</option>
                            <option>D</option>
                            <option>E</option>
                            <option>F</option>
                                       <option>S</option>
                        </select>
                        </div>
                        </div>
                    </div>
                    </div>
                    <div class="col-sm-4">
                    <div class="col-sm-12">
                        <div class="form-group">
                        <label  class="col-sm-8 control-label">Mathematics</label>
                        <div class="col-sm-2">
                        <select name= "egmMathematics">
                            <option></option>
                            <option>A</option>
                            <option>B</option>
                            <option>C</option>
                            <option>D</option>
                            <option>E</option>
                            <option>F</option>
                                       <option>S</option>
                        </select>
                        </div>
                        </div>
                    </div>
                    </div>
                  </div>
                </div>
                <div id="cbg">        
                  <div class="col-sm-12">
                    <div class="col-sm-4">
                    <div class="col-sm-12">
                        <div class="form-group">
                        <label  class="col-sm-8 control-label">Chemistry</label>
                        <div class="col-sm-2">
                        <select name= "cbgChemistry">
                            <option></option>
                            <option>A</option>
                            <option>B</option>
                            <option>C</option>
                            <option>D</option>
                            <option>E</option>
                            <option>F</option>
                                       <option>S</option>
                        </select>
                        </div>
                        </div>
                    </div>
                    </div>
                    <div class="col-sm-4">
                    <div class="col-sm-12">
                        <div class="form-group">
                        <label  class="col-sm-8 control-label">Biology</label>
                        <div class="col-sm-2">
                        <select name= "cbgBiology">
                            <option></option>
                            <option>A</option>
                            <option>B</option>
                            <option>C</option>
                            <option>D</option>
                            <option>E</option>
                            <option>F</option>
                                       <option>S</option>
                        </select>
                        </div>
                        </div>
                    </div>
                    </div>
                    <div class="col-sm-4">
                    <div class="col-sm-12">
                        <div class="form-group">
                        <label  class="col-sm-8 control-label">Geography</label>
                        <div class="col-sm-2">
                        <select name= "cbgGeography">
                            <option></option>
                            <option>A</option>
                            <option>B</option>
                            <option>C</option>
                            <option>D</option>
                            <option>E</option>
                            <option>F</option>
                                       <option>S</option>
                        </select>
                        </div>
                        </div>
                    </div>
                    </div>
                  </div>
                </div>
                <div id="hgk">        
                  <div class="col-sm-12">
                    <div class="col-sm-4">
                    <div class="col-sm-12">
                        <div class="form-group">
                        <label  class="col-sm-8 control-label">History</label>
                        <div class="col-sm-2">
                        <select name= "hgkHistory">
                            <option></option>
                            <option>A</option>
                            <option>B</option>
                            <option>C</option>
                            <option>D</option>
                            <option>E</option>
                            <option>F</option>
                                       <option>S</option>
                        </select>
                        </div>
                        </div>
                    </div>
                    </div>
                    <div class="col-sm-4">
                    <div class="col-sm-12">
                        <div class="form-group">
                        <label  class="col-sm-8 control-label">Geography</label>
                        <div class="col-sm-2">
                        <select name= "hgkGeography">
                            <option></option>
                            <option>A</option>
                            <option>B</option>
                            <option>C</option>
                            <option>D</option>
                            <option>E</option>
                            <option>F</option>
                                       <option>S</option>
                        </select>
                        </div>
                        </div>
                    </div>
                    </div>
                    <div class="col-sm-4">
                    <div class="col-sm-12">
                        <div class="form-group">
                        <label  class="col-sm-8 control-label">Kiswahili</label>
                        <div class="col-sm-2">
                        <select name= "hgkKiswahili">
                            <option></option>
                            <option>A</option>
                            <option>B</option>
                            <option>C</option>
                            <option>D</option>
                            <option>E</option>
                            <option>F</option>
                             <option>S</option>
                        </select>
                        </div>
                        </div>
                    </div>
                    </div>
                  </div>
                </div>
                <div id="hgl">        
                  <div class="col-sm-12">
                    <div class="col-sm-4">
                    <div class="col-sm-12">
                        <div class="form-group">
                        <label  class="col-sm-8 control-label">History</label>
                        <div class="col-sm-2">
                        <select name= "hglHistory">
                            <option></option>
                            <option>A</option>
                            <option>B</option>
                            <option>C</option>
                            <option>D</option>
                            <option>E</option>
                            <option>F</option>
                                       <option>S</option>
                        </select>
                        </div>
                        </div>
                    </div>
                    </div>
                    <div class="col-sm-4">
                    <div class="col-sm-12">
                        <div class="form-group">
                        <label  class="col-sm-8 control-label">Geography</label>
                        <div class="col-sm-2">
                        <select name= "hglGeography">
                            <option></option>
                            <option>A</option>
                            <option>B</option>
                            <option>C</option>
                            <option>D</option>
                            <option>E</option>
                            <option>F</option>
                                       <option>S</option>
                        </select>
                        </div>
                        </div>
                    </div>
                    </div>
                    <div class="col-sm-4">
                    <div class="col-sm-12">
                        <div class="form-group">
                        <label  class="col-sm-8 control-label">Language</label>
                        <div class="col-sm-2">
                        <select name = "hglLanguage">
                            <option></option>
                            <option>A</option>
                            <option>B</option>
                            <option>C</option>
                            <option>D</option>
                            <option>E</option>
                            <option>F</option> 
                            <option>S</option>
                        </select>
                        </div>
                        </div>
                    </div>
                    </div>
                  </div>
                </div>
                <div id="hkl">        
                  <div class="col-sm-12">
                    <div class="col-sm-4">
                    <div class="col-sm-12">
                        <div class="form-group">
                        <label  class="col-sm-8 control-label">History</label>
                        <div class="col-sm-2">
                        <select name= "hklHistory">
                            <option></option>
                            <option>A</option>
                            <option>B</option>
                            <option>C</option>
                            <option>D</option>
                            <option>E</option>
                            <option>F</option>
                                       <option>S</option>
                        </select>
                        </div>
                        </div>
                    </div>
                    </div>
                    <div class="col-sm-4">
                    <div class="col-sm-12">
                        <div class="form-group">
                        <label  class="col-sm-8 control-label">Kiswahili</label>
                        <div class="col-sm-2">
                        <select name= "hklKiswahili">
                            <option></option>
                            <option>A</option>
                            <option>B</option>
                            <option>C</option>
                            <option>D</option>
                            <option>E</option>
                            <option>F</option>
                                       <option>S</option>
                        </select>
                        </div>
                        </div>
                    </div>
                    </div>
                    <div class="col-sm-4">
                    <div class="col-sm-12">
                        <div class="form-group">
                        <label  class="col-sm-8 control-label">Language</label>
                        <div class="col-sm-2">
                        <select name = "hklLanguage">
                            <option></option>
                            <option>A</option>
                            <option>B</option>
                            <option>C</option>
                            <option>D</option>
                            <option>E</option>
                            <option>F</option>
                                       <option>S</option>
                        </select>
                        </div>
                        </div>
                    </div>
                    </div>
                  </div>
                </div>
                </div>
                </div>
                </div>
                </div>
                
                
                <hr>
            

                <h4 class="text-center">TAARIFA KUHUSU NDUGU WA KARIBU:</h4>
 

         
                <div class="form-group">
                    <label for="Last Name" class="col-sm-2 control-label">JINA KAMILI:</label>
                    <div class="col-sm-9">
                    <input type="text" name="ndgName" class="form-control" id="Last Name" placeholder="JINA KAMILI LA NDUGU WA KARIBU">
                    </div>
                </div>
                             </hr>

                <div class="form-group">
                  <label for="" class="col-sm-2 control-label">JINSIA:</label>
                  <div class="col-sm-9">
                  <label class="radio-inline">
                  <input type="radio" name="ndgJinsia"  value="Male">ME
                  </label>
                  <label class="radio-inline">
                  <input type="radio" name="ndgJinsia"  value="Female">KE
                  </label>
                  </div>
                </div>


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 <h4 class="text-center">ULIJUAJE KUHUSU HISANI INSTITUTE OF HEALTH ALLIED SCIENCES</h4>
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<option value=""> </option>
<option>FACEBOOK/INSTAGRAM</option>
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<option>MATANGAZO YA TV</option>
<option>MTANDAO WA NACTVET</option>
<option>MATANGAZO YA RADIO</option>
<option>GUIDE BOOK YA NACTVET</option>

</select> 
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                                  <option>KUPITIA KWA MWALIMU WA SEKONDARI</option>
                                 
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                <strong>Form hii hailipiwi,inajazwa bure</B>
     <BR></strong>
                
                <strong>Kwa msaada piga namba hizi:</strong>
                <i><B>07 46 01 39 92 au 06 73 13 99 26.</B></i></strong>
<br>
                
             KWA WANAFUNZI WANAOTAKA KUHAMIA <BR>
WAFUATE TARATIBU ZILIZOWEKWA NA NACTVET, <B> <FONT COLOR="BLUE">
 ASANTEH!!! </FONT></B></p> </p>

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