WebT/Assignment1.html at main · lifeiswe/WebT · GitHub

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<!DOCTYPE html>
<html lang="en">
<head>
    <meta charset="UTF-8">
    <meta name="viewport" content="width=device-width, initial-scale=1.0">
    <link rel="stylesheet" href="stylesheet.css">
    <title>Re-Evalution Request</title>
</head>
<body>
    <div align="center"><img src="logoPesu.png" alt="PESU Logo" id="logo" width="200" align="center"> <!-- PESU Logo at top center --></div>
    <h2>Re-evaluation Request Form</h2>
    <div id="fullform">
    <table  class=tab style="font-size:25px" border="" align="center">
    <form method="post" action="" target="_blank">
        <tr width="100">
            <td>
                Name:
            </td>
            <td>
                <input class="textbox" type="text" name="f_name" placeholder="Enter your name" required="required">
            </td>
        </tr>
        <tr>
            <td>
                SRN:
            </td>
            <td>
                <input class="textbox" type="text" name="srn" placeholder="Enter your SRN" required="required">
            </td>
        </tr>
        <tr>
            <td>
                Gender:
            </td>
            <td>
                <input type="radio" name="g1" value="male">Male
                <input type="radio" name="g1" value="female">Female
            </td>
        </tr>
        <tr>
            <td>
                Email:
            </td>
            <td>
                <input class="textbox" type="email" pattern="[a-z0-9._%+-]+@[a-z0-9.-]+\.[a-z]{2,4}$"  placeholder="Enter your mail ID" required="required">
            </td>
        </tr>
        <tr>
            <td>
                Phone No.:
            </td>
            <td>
                <input class="textbox" type="tel" pattern="[6-9]{1}[0-9]{9}" placeholder="Enter your mobile no."required="required">
            </td>
        </tr>
        <tr>
            <td>
                Date Of Request:
            </td>
            <td>
                <input type="date" required="required">
            </td>
        </tr>
        <tr>
            <td>
                Subject:
            </td>
            <td>
                <select name="subject" id="subject0" placeholder="Select your subject">
                    <option value="">Select an option</option>
                    <option value="wt">Web Technology</option>
                    <option value="sds">Statistics in Data Science</option>
                    <option value="dsa">Data structure and its application</option>
                    <option value="ddco">Digital Design and Computer organisation </option>
                    <option value="afll">Automata Formal language and logic</option>
                </select>

            </td>
        </tr>

        <tr>
            <td colspan="2"><input type="checkbox" required="required">I hereby confirm my details</td>
        </tr>
        <tr>
            <td>
            <button type="submit" ondblclick="f1()">Submit</button></td>
            <td><button type="reset">reset</button></td>
        </tr>
    </form>
    </table>
    </div>
    <script type="text/javascript">
        function f1() {
            alert("Successfully submitted");}
        </script>
</body>
</html>