source: WAeUP_SRP/trunk/skins/waeup_student/support_form.pt @ 999

<metal:html tal:define="info context/getStudentInfo;
                ">
  <metal:body use-macro="here/main_template/macros/master">
    <metal:main fill-slot="main">
      <h3>Support/Enquiries Form</h3>
      <br />If you are having problems using the system please fill the form below with your correct details.<br /> <br /> 
      <form id="form1" name="form1" method="post" action="mail2admin">
      <input type="hidden" name="regno" type="text" id="regno"
             tal:attributes="value info/id"/>
      <table width="100%" border="0" cellspacing="5" cellpadding="0">
        <tr>
          <td width="150px">
             <strong>Full Name: </strong>
          </td>
          <td>
             <input name="fullname" type="text" id="fullname" 
                    tal:attributes="value info/student/Title"/>
          </td>
        </tr>
        <tr>
          <td>
             <strong>Email: </strong>
          </td>
          <td>
             <input name="email" type="text" id="email" 
                    tal:attributes="value info/app_doc/app_email"/>
          </td>
        </tr>
        <tr>
          <td>
             <strong>Problem Type: </strong>
          </td>
          <td>
              <select name="probtype" class="boxgreen" id="probtype">
                <option>Payment</option>
                <option>Application</option>
                <option>Admission</option>
                <option>Clearance</option>
                <option>Course Registration</option>
                <option>Hostal Reservation</option>                                
                <option>Other</option>
              </select>        
          </td>
        </tr>
        <tr>
          <td valign="top">
             <strong>Description: </strong>
          </td>
          <td>
             <textarea name="descr" rows="10" cols="60" id="descr"></textarea>
          </td>
        </tr>
      
        <tr>
          <td>&nbsp;</td>
          <td><input name="Submit" type="submit" class="standalone" value="Submit" /><br /><br /></td>
        </tr>
      </table>
      </form>
    </metal:main>
  </metal:body>
</metal:html>