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  1. <?php
  2. session_start();
  3. include 'connector.php';
  4.  
  5. //Obtained from manage_login.php:
  6. $loginId = $_SESSION["userid"];
  7. $appId = $_SESSION["appId"];
  8.  
  9. // Check if userid is set
  10. if (!(isset($_SESSION["userid"]))) {
  11. // Redirect to this location
  12. header("location:login2.html?login=required");
  13. }
  14.  
  15. //Variables for user input:
  16. $array = array_fill_keys(
  17. array("fname", "mname", "lname", "prevlname", "suffix", "email", "phone", "dob", "country", "psadd1", "psadd2", "pcity", "pstate", "pzip", "lsadd1", "lsadd2", "lcity", "lstate", "lzip", "citizenshipship", "ssn", "race", "maritalstatus", "ethnicity", "gender"), "");
  18. $array["dob"] = date('Y-m-d', strtotime(""));
  19.  
  20. //Variables for error handling:
  21. $canSave = true;
  22. $fnameErr = $mnameErr = $lnameErr = $prevLnameErr = "";
  23. $phoneErr = $emailErr = $dobErr = $countryErr = "";
  24. $sadd1Err = $sadd2Err = $pcityErr = $pstateErr = $lzipErr = $pzipErr = "";
  25. $citizenshipErr = $ssnErr = "";
  26. $ethnicityErr = $genderErr = "";
  27.  
  28. //For masking:
  29. $ssn_masked = "";
  30.  
  31. //Autocompletes all fields with pre-existing data:
  32. $pgsql = "SELECT * FROM public.fetch_personal_information('$appId') as f(fname varchar, mname varchar, lname varchar, prevlname varchar, suffix varchar, email varchar, phone varchar, dob date, country varchar, psadd1 varchar, psadd2 varchar, pcity varchar, pstate varchar, pzip varchar, lsadd1 varchar, lsadd2 varchar, lcity varchar, lstate varchar, lzip varchar, citizenshipship varchar, ssn varchar, race varchar, maritalstatus varchar, ethnicity varchar, gender varchar)";
  33. // $pgsql = "SELECT public.fetch_personal_information('$appId')";
  34. $resultset = pg_query($connection, $pgsql) or die("Could not query!");
  35.  
  36. if($row = pg_fetch_assoc($resultset)){
  37. $keys = array_keys($array);
  38. foreach($keys as $key){
  39. $array[$key] = $row[$key];
  40. }
  41. unset($key);
  42. }
  43. $ssn_masked = "###-##-" . substr($array["ssn"], 7);
  44.  
  45.  
  46. //If the 'Save' button is pressed:
  47. if (isset($_POST['save'])){
  48.  
  49. /* Name and Personal Info Fields */
  50. //first name:
  51. if(isset($_POST["fname"]) && !empty($_POST["fname"])){
  52. $array["fname"] = pg_escape_string($connection, $_POST["fname"]);
  53. if (!preg_match("/^[a-zA-Z'\- ]*$/",$array["fname"])) {
  54. $fnameErr = "Only letters, white spaces, hyphens, and apostrophes allowed";
  55. }
  56. else $fnameErr = "";
  57. }
  58.  
  59. //middle name:
  60. if(isset($_POST["mname"]) && !empty($_POST["mname"])){
  61. $array["mname"] = pg_escape_string($connection, $_POST["mname"]);
  62. if (!preg_match("/^[a-zA-Z'\- ]*$/",$array["mname"])) {
  63. $mnameErr = "Only letters, white spaces, hyphens, and apostrophes allowed";
  64. }
  65. else $mnameErr = "";
  66. }
  67.  
  68. //last name:
  69. if(isset($_POST["lname"]) && !empty($_POST["lname"])){
  70. $array["lname"] = pg_escape_string($connection, $_POST["lname"]);
  71. if (!preg_match("/^[a-zA-Z'\- ]*$/",$array["lname"])) {
  72. $lnameErr = "Only letters, white spaces, hyphens, and apostrophes allowed";
  73. }
  74. else $lnameErr = "";
  75. }
  76.  
  77. //last name:
  78. if(isset($_POST["prevlname"]) && !empty($_POST["prevlname"])){
  79. $array["prevlname"] = pg_escape_string($connection, $_POST["prevlname"]);
  80. if (!preg_match("/^[a-zA-Z'\- ]*$/",$array["prevlname"])) {
  81. $prevLnameErr = "Only letters, white spaces, hyphens, and apostrophes allowed";
  82. }
  83. else $prevLnameErr = "";
  84. }
  85.  
  86. //suffix:
  87. if(isset($_POST["suffixSelect"]) && !empty($_POST["suffixSelect"])){
  88. $array["suffix"] = pg_escape_string($connection, $_POST["suffixSelect"]);
  89. }
  90.  
  91. //email address:
  92. if(isset($_POST["email"]) && !empty($_POST["email"])){
  93. $array["email"] = pg_escape_string($connection, $_POST["email"]);
  94. if (!filter_var($array["email"], FILTER_VALIDATE_EMAIL)) {
  95. $emailErr = "Invalid email format";
  96. }
  97. else $emailErr = "";
  98. }
  99.  
  100. //phone number:
  101. if(isset($_POST["phone"]) && !empty($_POST["phone"])){
  102. $array["phone"] = pg_escape_string($connection, $_POST["phone"]);
  103. if (!preg_match("/\d{3}-\d{3}-\d{4}/",$array["phone"]) || strlen($array["phone"]) != 12) {
  104. $phoneErr = "Only numbers and hyphens allowed";
  105. }
  106. else $phoneErr = "";
  107. }
  108.  
  109. //date of birth:
  110. if(isset($_POST["dob"]) && !empty($_POST["dob"])){
  111. $array["dob"] = pg_escape_string($connection, $_POST["dob"]);
  112. }
  113.  
  114. /* Permanent Address Fields */
  115.  
  116. //country:
  117. if(isset($_POST["country"]) && !empty($_POST["country"])){
  118. $array["country"] = pg_escape_string($connection, $_POST["country"]);
  119. if (!preg_match("/^[a-zA-Z\- ]*$/",$array["country"])) {
  120. $countryErr = "Only letters, white spaces, and hyphens allowed";
  121. }
  122. else $countryErr = "";
  123. }
  124.  
  125. //street address 1:
  126. if(isset($_POST["sadd1"]) && !empty($_POST["sadd1"])){
  127. $array["psadd1"] = pg_escape_string($connection, $_POST["sadd1"]);
  128. }
  129.  
  130. //street address 2:
  131. if(isset($_POST["sadd2"]) && !empty($_POST["sadd2"])){
  132. $array["psadd2"] = pg_escape_string($connection, $_POST["sadd2"]);
  133. }
  134.  
  135. //city:
  136. if(isset($_POST["pcity"]) && !empty($_POST["pcity"])){
  137. $array["pcity"] = pg_escape_string($connection, $_POST["pcity"]);
  138. }
  139.  
  140. //state:
  141. if(isset($_POST["pstateSelect"]) && !empty($_POST["pstateSelect"])){
  142. $array["pstate"] = pg_escape_string($connection, $_POST["pstateSelect"]);
  143. }
  144.  
  145. //zip code:
  146. if(isset($_POST["pzip"]) && !empty($_POST["pzip"])){
  147. $array["pzip"] = pg_escape_string($connection, $_POST["pzip"]);
  148. if(preg_match("/^[a-zA-Z'\- ]*$/",$array["pzip"])){
  149. $pzipErr = "Only numbers are allowed";
  150. }
  151. else $pzipErr = "";
  152. }
  153.  
  154. /* Local Address Fields */
  155. //street address 1:
  156. if(isset($_POST["lsadd1"]) && !empty($_POST["lsadd1"])){
  157. $array["lsadd1"] = pg_escape_string($connection, $_POST["lsadd1"]);
  158. }
  159.  
  160. //street address 2:
  161. if(isset($_POST["lsadd2"]) && !empty($_POST["lsadd2"])){
  162. $array["lsadd2"] = pg_escape_string($connection, $_POST["lsadd2"]);
  163. }
  164.  
  165. //city:
  166. if(isset($_POST["lcity"]) && !empty($_POST["lcity"])){
  167. $array["lcity"] = pg_escape_string($connection, $_POST["lcity"]);
  168. }
  169.  
  170. //state:
  171. if(isset($_POST["lstateSelect"]) && !empty($_POST["lstateSelect"])){
  172. $array["lstate"] = pg_escape_string($connection, $_POST["lstateSelect"]);
  173. }
  174.  
  175. //zip code:
  176. if(isset($_POST["lzip"]) && !empty($_POST["lzip"])){
  177. $array["lzip"] = pg_escape_string($connection, $_POST["lzip"]);
  178. if(preg_match("/^[a-zA-Z'\- ]*$/",$array["lzip"])){
  179. $lzipErr = "Only numbers are allowed";
  180. }
  181. else $lzipErr = "";
  182. }
  183.  
  184. /* citizenshipship Status */
  185. //citizenshipship:
  186. if (isset($_POST["citizenship"]) && !empty($_POST["citizenship"])) {
  187. $array["citizenshipship"] = pg_escape_string($connection, $_POST["citizenship"]);
  188. }
  189.  
  190. //social security number:
  191. if(isset($_POST["ssn_value"]) &&!empty($_POST["ssn_value"])){
  192. $array["ssn"] = pg_escape_string($connection, $_POST["ssn_value"]);
  193. if (!preg_match("/\d{3}-\d{2}-\d{4}/",$array["ssn"])|| strlen($array["ssn"]) != 11) {
  194. $ssnErr = "Your ssn should match the format: ###-##-####";
  195. }
  196. else{
  197. $ssnErr = "";
  198. $ssn_masked = "###-##-" . substr($array["ssn"], 7);
  199. }
  200. }
  201. /* Demographics */
  202. //race:
  203. if(isset($_POST["raceSelect"]) && !empty($_POST["raceSelect"])){
  204. $array["race"] = pg_escape_string($connection, $_POST["raceSelect"]);
  205. }
  206.  
  207. //marital status:
  208. if (isset($_POST["maritalSelect"]) && !empty($_POST["maritalSelect"])){
  209. $array["maritalstatus"] = pg_escape_string($connection, $_POST["maritalSelect"]);
  210. }
  211.  
  212. //ethnicity:
  213. if(isset($_POST["ethnicity"]) && !empty($_POST["ethnicity"])){
  214. $array["ethnicity"] = pg_escape_string($connection, $_POST["ethnicity"]);
  215. }
  216.  
  217. //gender:
  218. if(isset($_POST["gender"]) && !empty($_POST["gender"])){
  219. $array["gender"] = pg_escape_string($connection, $_POST["gender"]);
  220. }
  221.  
  222. //Check for errors:
  223. $canSave = checkErrors($fnameErr, $mnameErr, $lnameErr, $prevLnameErr, $phoneErr, $emailErr, $dobErr, $countryErr, $sadd1Err, $sadd2Err, $pcityErr, $pstateErr, $lzipErr, $pzipErr, $citizenshipErr, $ssnErr, $ethnicityErr, $genderErr);
  224.  
  225. //If no errors, update the database:
  226. if($canSave){
  227. $pgsql = "SELECT * FROM public.personal_information('$appId', '$array[fname]', '$array[mname]', '$array[lname]', '$array[prevlname]', '$array[suffix]', '$array[email]', '$array[phone]', '$array[dob]', '$array[country]', '$array[psadd1]', '$array[psadd2]', '$array[pcity]', '$array[pstate]', '$array[pzip]', '$array[lsadd1]', '$array[lsadd2]', '$array[lcity]', '$array[lstate]', '$array[lzip]', '$array[citizenshipship]', '$array[ssn]', '$array[race]', '$array[maritalstatus]', '$array[ethnicity]', '$array[gender]')";
  228. $resultset = pg_query($connection, $pgsql);
  229.  
  230. pg_free_result($resultset);
  231. }
  232. }
  233.  
  234. //If the 'Cancel' button is pressed:
  235. if (isset($_POST['cancel'])){
  236. header("Location: ../home.html");
  237. exit();
  238. }
  239.  
  240. //Checks if any of the error handling variables contain an error message:
  241. function checkErrors($fnameErr, $mnameErr, $lnameErr, $phoneErr, $emailErr, $dobErr, $sadd1Err, $sadd2Err, $pcityErr, $pstateErr, $lzipErr, $pzipErr, $citizenshipErr, $ssnErr, $ethnicityErr, $genderErr){
  242. $errors = array($fnameErr, $mnameErr, $lnameErr, $phoneErr, $emailErr, $dobErr, $sadd1Err, $sadd2Err, $pcityErr, $pstateErr, $lzipErr, $pzipErr, $citizenshipErr, $ssnErr, $ethnicityErr, $genderErr);
  243. foreach($errors as $error){
  244. if(!empty($error)){
  245. return false;
  246. }
  247. }
  248. return true;
  249. }
  250. ?>
  251.  
  252. <!DOCTYPE html>
  253. <html>
  254.  
  255. <head>
  256. <title>TSU Graduate Admissions</title>
  257. <meta charset="utf-8">
  258. <meta name="viewport" content="width=device-width, initial-scale=1">
  259. <link rel="stylesheet" href="https://maxcdn.bootstrapcdn.com/bootstrap/3.3.7/css/bootstrap.min.css">
  260. <script src="https://ajax.googleapis.com/ajax/libs/jquery/3.2.1/jquery.min.js"></script>
  261. <script src="https://maxcdn.bootstrapcdn.com/bootstrap/3.3.7/js/bootstrap.min.js"></script>
  262.  
  263. <script>
  264. $(document).ready(function(){
  265. //Tooltip:
  266. $('[data-toggle="tooltip"]').tooltip();
  267. });
  268. </script>
  269.  
  270. <script>
  271. //Phone Number - adding dashes between numbers:
  272. function addDashes(value) {
  273. value = value.replace(/\D/g, "");
  274. if(value.length == 10){
  275. value = value.slice(0,3) + "-" + value.slice(3,6) + "-" + value.slice(6,15);
  276. document.getElementById("phone").value = value;
  277. }
  278. else{
  279. document.getElementById("phone").value = "";
  280. }
  281. }
  282. </script>
  283.  
  284. <script>
  285. //Social Security Number - adding dashes between numbers, masking:
  286. function modifyssn(value) {
  287. value = value.replace(/\D/g, "");
  288. if(value.length == 9){
  289. value = value.slice(0,3) + "-" + value.slice(3,5) + "-" + value.slice(5,15);
  290. document.getElementById("ssn_value").value = value;
  291. document.getElementById("ssn").value = "###-##-" + value.substring(7);
  292. }
  293. else{
  294. document.getElementById("ssn_value").value = "";
  295. document.getElementById("ssn").value = "Invalid input.";
  296. }
  297. }
  298. </script>
  299.  
  300. <style>
  301. .card {
  302. margin: 2em 0;
  303. padding: 2em;
  304. box-shadow: 0 3px 6px rgba(0, 0, 0, 0.16), 0 3px 6px rgba(0, 0, 0, 0.23);
  305. background-color: #F5F5F5;
  306. /*WhiteSmoke */
  307. }
  308.  
  309. .card:hover {
  310. box-shadow: 0 6px 14px rgba(0, 0, 0, 0.25), 0 8px 8px rgba(0, 0, 0, 0.22);
  311. }
  312.  
  313. .card .glyphicon {
  314. font-size: 4em;
  315. margin-bottom: 0.8em;
  316. padding 2em;
  317. }
  318.  
  319. .card-header {
  320. font-size: 2.875em;
  321. text-transform: uppercase;
  322. <!-- margin-bottom: 1em; -->
  323. text-align: center;
  324. }
  325.  
  326. .card .btn {
  327. text-transform: uppercase;
  328. }
  329.  
  330. .card .btn:hover {
  331. box-shadow: 0 10px 20px rgba(0, 0, 0, 0.19), 0 6px 6px rgba(0, 0, 0, 0.23);
  332. }
  333.  
  334. .error {color: #FF0000;}
  335. </style>
  336. </head>
  337.  
  338. <body>
  339. <!-------------------- Begin Navigation Bar ----------------------------->
  340. <nav class="navbar navbar-inverse">
  341. <div class="container-fluid">
  342. <div class="navbar-header">
  343. <button type="button" class="navbar-toggle" data-toggle="collapse" data-target="#myNavbar"> <span class="icon-bar"></span> <span class="icon-bar"></span> <span class="icon-bar"></span> </button>
  344. <a class="navbar-brand" href="#">
  345. <img border="0" alt="TSU" src="tsu.png" width="42" height="42"> </a>
  346. </div>
  347. <div class="collapse navbar-collapse" id="myNavbar">
  348. <ul class="nav navbar-nav">
  349. <li class="active">
  350. <a href="#">Home</a>
  351. </li>
  352. <li class="dropdown">
  353. <a class="dropdown-toggle" data-toggle="dropdown" href="#">Degrees<span class="caret"></span></a>
  354. <ul class="dropdown-menu">
  355. <li>
  356. <a href="#">Math</a>
  357. </li>
  358. <li>
  359. <a href="#">Nursing</a>
  360. </li>
  361. <li>
  362. <a href="#">Computer Science</a>
  363. </li>
  364. </ul>
  365. </li>
  366. <li>
  367. <a href="#">Requirements</a>
  368. </li>
  369. <li>
  370. <a href="#">About</a>
  371. </li>
  372. </ul>
  373. <ul class="nav navbar-nav navbar-right">
  374. <li>
  375. <a href="#"><span class="glyphicon glyphicon-user"></span> <?=$loginId?> </a>
  376. </li>
  377. <li>
  378. <a href="login2.html"><span class="glyphicon glyphicon-log-out"></span> Logout</a>
  379. </li>
  380. </ul>
  381. </div>
  382. </div>
  383. </nav>
  384. <section class="container-fluid">
  385.  
  386. <!-- Begin Card -->
  387. <div class="card">
  388. <h2 class="card-header text-center mb-3;">Personal Data</h2>
  389. <div class="card-body">
  390. <p class="card-text"><span class="error">* Required Field</span></p>
  391. </div>
  392.  
  393. <form method="post" id="piphpform" action="<?=htmlspecialchars($_SERVER["PHP_SELF"])?>">
  394.  
  395. <!-- Name information -->
  396. <!-- First Name Input -->
  397. <div class="form-group">
  398. <label for="fnameInput">First Name<span class="error"> * <?=$fnameErr?></span></label>
  399. <input type="text" class="form-control" name="fname" id="fname" value="<?=$array["fname"]?>" placeholder="Enter First Name" data-toggle="tooltip" title="Letters, white spaces, hyphens, and apostrophes are allowed for the First (Given) Name">
  400. </div>
  401. <!-- Middle Name Input -->
  402. <div class="form-group">
  403. <label for="mnameInput">Middle Name<span class="error"> * <?=$mnameErr?></span></label>
  404. <input type="text" class="form-control" name="mname" id="mname" value="<?=$array["mname"]?>" placeholder="Enter Middle Name" data-toggle="tooltip" title="Letters, white spaces, hyphens, and apostrophes are allowed for the Middle Name">
  405. </div>
  406. <!-- Last Name Input -->
  407. <div class="form-group">
  408. <label for="lnameInput">Last Name<span class="error"> * <?=$lnameErr?></span></label>
  409. <input type="text" class="form-control" name="lname" id="lname" value="<?=$array["lname"]?>" placeholder="Enter Last Name" data-toggle="tooltip" title="Letters, white spaces, hyphens, and apostrophes are allowed for the Last (Family/Surname) Name">
  410. </div>
  411. <!-- Previous Last Name Input -->
  412. <div class="form-group">
  413. <label for="prevlnameInput">Previous Last Name<span class="error"> <?php echo $prevLnameErr;?></span></label>
  414. <input type="text" class="form-control" name="prevlname" id="prevlname" value="<?=$array["prevlname"]?>" placeholder="Enter Previous Last Name" data-toggle="tooltip" title="Letters, white spaces, hyphens, and apostrophes are allowed for the Last (Family/Surname) Name">
  415. </div>
  416. <!-- Suffix Select -->
  417. <div class="form-group">
  418. <label class="mr-sm-2" for="suffixSelect">Suffix</label>
  419. <select class="custom-select mb-4 mr-sm-4 mb-sm-2" name="suffixSelect" data-toggle="tooltip" title="Select your suffix from the dropdown list">
  420. <option value="">Choose...</option>
  421. <option <?php if ($array["suffix"] =="Sr") echo "selected";?> value="Sr">Sr</option>
  422. <option <?php if ($array["suffix"] =="Jr") echo "selected";?> value="Jr">Jr</option>
  423. <option <?php if ($array["suffix"] =="II") echo "selected";?> value="II">II</option>
  424. <option <?php if ($array["suffix"] =="III") echo "selected";?> value="III">III</option>
  425. <option <?php if ($array["suffix"] =="IV") echo "selected";?> value="IV">IV</option>
  426. <option <?php if ($array["suffix"] =="V") echo "selected";?> value="V">V</option>
  427. <option <?php if ($array["suffix"] =="VI") echo "selected";?> value="VI">VI</option>
  428. <option <?php if ($array["suffix"] =="VII") echo "selected";?> value="VII">VII</option>
  429. </select>
  430. </div>
  431. <!-- End Name information -->
  432.  
  433. <!-- Email Input -->
  434. <div class="form-group">
  435. <label for="emailform">Email address<span class="error"> * <?=$emailErr?></span></label>
  436. <input type="email" class="form-control" name="email" id="emailform" value="<?=$array["email"]?>" aria-describedby="emailHelp" data-toggle="tooltip" title="Example email address: someone@example.com"placeholder="Enter email"> <small id="emailHelp" class="form-text text-muted">We'll never share your email with anyone else.</small>
  437. </div>
  438. <!-- Phone Number Input -->
  439. <div class="form-group">
  440. <label for="phoneForm">Phone Number<span class="error"> * <?=$phoneErr?></span></label>
  441. <input type="tel" name="phone" id="phone" value="<?=$array["phone"]?>" data-format="ddd-ddd-dddd" data-toggle="tooltip" title="Example US Phone Number: 555-555-5555" placeholder="###-###-####" pattern="\d{3}-\d{3}-\d{4}" class="form-control bfh-phone" maxlength="12" onBlur="addDashes(this.value)">
  442. </div>
  443. <!-- DOB date Input -->
  444. <div class="form-group">
  445. <label for="dobForm" class="col-2 col-form-label" id="dobForm">Date of Birth <span class="error"> * <?=$dobErr?> </label>
  446. <div class="col-10">
  447. <input class="form-control" type="date" name="dob" id="dob" data-toggle="tooltip" title="Select down arrow on the far right of this textfield to use the calendar" value="<?=$array["dob"]?>" >
  448. </span>
  449. </div>
  450. </div>
  451.  
  452. <!-- Permanent Address information -->
  453. <fieldset class="form-group">
  454. <legend>Permanent Address</legend>
  455. <!-- Country Input -->
  456. <div class="form-group">
  457. <label for="countryInput">Country<span class="error"> * <?php echo $countryErr;?></span></label>
  458. <input type="text" list="defaultCountries" class="form-control" name="country" id="country" value="<?=$array["country"]?>" data-toggle="tooltip" title="Enter the Country of your permanent address" placeholder="Enter Country" required >
  459. <!-- Suggestion options for Country Input -->
  460. <datalist id="defaultCountries">
  461. <option <?php if ($array["country"] =="Afghanistan") echo "selected";?> value="Afghanistan"></option>
  462. <option <?php if ($array["country"] =="Albania") echo "selected";?> value="Albania"></option>
  463. <option <?php if ($array["country"] =="Algeria") echo "selected";?> value="Algeria"></option>
  464. <option <?php if ($array["country"] =="Andorra") echo "selected";?> value="Andorra"></option>
  465. <option <?php if ($array["country"] =="Angola") echo "selected";?> value="Angola"></option>
  466. <option <?php if ($array["country"] =="Anguilla") echo "selected";?> value="Anguilla"></option>
  467. <option <?php if ($array["country"] =="Antigua & Barbuda") echo "selected";?> value="Antigua & Barbuda"></option>
  468. <option <?php if ($array["country"] =="Argentina") echo "selected";?> value="Argentina"></option>
  469. <option <?php if ($array["country"] =="Armenia") echo "selected";?> value="Armenia"></option>
  470. <option <?php if ($array["country"] =="Aruba") echo "selected";?> value="Aruba"></option>
  471. <option <?php if ($array["country"] =="Australia") echo "selected";?> value="Australia"></option>
  472. <option <?php if ($array["country"] =="Austria") echo "selected";?> value="Austria"></option>
  473. <option <?php if ($array["country"] =="Azerbaijan") echo "selected";?> value="Azerbaijan"></option>
  474. <option <?php if ($array["country"] =="Bahamas") echo "selected";?> value="Bahamas"></option>
  475. <option <?php if ($array["country"] =="Bahrain") echo "selected";?> value="Bahrain"></option>
  476. <option <?php if ($array["country"] =="Bangladesh") echo "selected";?> value="Bangladesh"></option>
  477. <option <?php if ($array["country"] =="Barbados") echo "selected";?> value="Barbados"></option>
  478. <option <?php if ($array["country"] =="Belarus") echo "selected";?> value="Belarus"></option>
  479. <option <?php if ($array["country"] =="Belgium") echo "selected";?> value="Belgium"></option>
  480. <option <?php if ($array["country"] =="Belize") echo "selected";?> value="Belize"></option>
  481. <option <?php if ($array["country"] =="Benin") echo "selected";?> value="Benin"></option>
  482. <option <?php if ($array["country"] =="Bermuda") echo "selected";?> value="Bermuda"></option>
  483. <option <?php if ($array["country"] =="Bhutan") echo "selected";?> value="Bhutan"></option>
  484. <option <?php if ($array["country"] =="Bolivia") echo "selected";?> value="Bolivia"></option>
  485. <option <?php if ($array["country"] =="Bosnia & Herzegovina") echo "selected";?> value="Bosnia & Herzegovina"></option>
  486. <option <?php if ($array["country"] =="Botswana") echo "selected";?> value="Botswana"></option>
  487. <option <?php if ($array["country"] =="Brazil") echo "selected";?> value="Brazil"></option>
  488. <option <?php if ($array["country"] =="British Virgin Islands") echo "selected";?> value="British Virgin Islands"></option>
  489. <option <?php if ($array["country"] =="Brunei") echo "selected";?> value="Brunei"></option>
  490. <option <?php if ($array["country"] =="Bulgaria") echo "selected";?> value="Bulgaria"></option>
  491. <option <?php if ($array["country"] =="Burkina Faso") echo "selected";?> value="Burkina Faso"></option>
  492. <option <?php if ($array["country"] =="Burundi") echo "selected";?> value="Burundi"></option>
  493. <option <?php if ($array["country"] =="Cambodia") echo "selected";?> value="Cambodia"></option>
  494. <option <?php if ($array["country"] =="Cameroon") echo "selected";?> value="Cameroon"></option>
  495. <option <?php if ($array["country"] =="Canada") echo "selected";?> value="Canada"></option>
  496. <option <?php if ($array["country"] =="Cape Verde") echo "selected";?> value="Cape Verde"></option>
  497. <option <?php if ($array["country"] =="Cayman Islands") echo "selected";?> value="Cayman Islands"></option>
  498. <option <?php if ($array["country"] =="Central Arfrican Republic") echo "selected";?> value="Central Arfrican Republic"></option>
  499. <option <?php if ($array["country"] =="Chad") echo "selected";?> value="Chad"></option>
  500. <option <?php if ($array["country"] =="Chile") echo "selected";?> value="Chile"></option>
  501. <option <?php if ($array["country"] =="China") echo "selected";?> value="China"></option>
  502. <option <?php if ($array["country"] =="Colombia") echo "selected";?> value="Colombia"></option>
  503. <option <?php if ($array["country"] =="Congo") echo "selected";?> value="Congo"></option>
  504. <option <?php if ($array["country"] =="Cook Islands") echo "selected";?> value="Cook Islands"></option>
  505. <option <?php if ($array["country"] =="Costa Rica") echo "selected";?> value="Costa Rica"></option>
  506. <option <?php if ($array["country"] =="Cote D Ivoire") echo "selected";?> value="Cote D Ivoire"></option>
  507. <option <?php if ($array["country"] =="Croatia") echo "selected";?> value="Croatia"></option>
  508. <option <?php if ($array["country"] =="Cuba") echo "selected";?> value="Cuba"></option>
  509. <option <?php if ($array["country"] =="Curacao") echo "selected";?> value="Curacao"></option>
  510. <option <?php if ($array["country"] =="Cyprus") echo "selected";?> value="Cyprus"></option>
  511. <option <?php if ($array["country"] =="Czech Republic") echo "selected";?> value="Czech Republic"></option>
  512. <option <?php if ($array["country"] =="Denmark") echo "selected";?> value="Denmark"></option>
  513. <option <?php if ($array["country"] =="Djibouti") echo "selected";?> value="Djibouti"></option>
  514. <option <?php if ($array["country"] =="Dominica") echo "selected";?> value="Dominica"></option>
  515. <option <?php if ($array["country"] =="Dominican Republic") echo "selected";?> value="Dominican Republic"></option>
  516. <option <?php if ($array["country"] =="Ecuador") echo "selected";?> value="Ecuador"></option>
  517. <option <?php if ($array["country"] =="Egypt") echo "selected";?> value="Egypt"></option>
  518. <option <?php if ($array["country"] =="El Salvador") echo "selected";?> value="El Salvador"></option>
  519. <option <?php if ($array["country"] =="Equatorial Guinea") echo "selected";?> value="Equatorial Guinea"></option>
  520. <option <?php if ($array["country"] =="Eritrea") echo "selected";?> value="Eritrea"></option>
  521. <option <?php if ($array["country"] =="Estonia") echo "selected";?> value="Estonia"></option>
  522. <option <?php if ($array["country"] =="Ethiopia") echo "selected";?> value="Ethiopia"></option>
  523. <option <?php if ($array["country"] =="Falkland Islands") echo "selected";?> value="Falkland Islands"></option>
  524. <option <?php if ($array["country"] =="Faroe Islands") echo "selected";?> value="Faroe Islands"></option>
  525. <option <?php if ($array["country"] =="Fiji") echo "selected";?> value="Fiji"></option>
  526. <option <?php if ($array["country"] =="Finland") echo "selected";?> value="Finland"></option>
  527. <option <?php if ($array["country"] =="France") echo "selected";?> value="France"></option>
  528. <option <?php if ($array["country"] =="French Polynesia") echo "selected";?> value="French Polynesia"></option>
  529. <option <?php if ($array["country"] =="French West Indies") echo "selected";?> value="French West Indies"></option>
  530. <option <?php if ($array["country"] =="Gabon") echo "selected";?> value="Gabon"></option>
  531. <option <?php if ($array["country"] =="Gambia") echo "selected";?> value="Gambia"></option>
  532. <option <?php if ($array["country"] =="Georgia") echo "selected";?> value="Georgia"></option>
  533. <option <?php if ($array["country"] =="Germany") echo "selected";?> value="Germany"></option>
  534. <option <?php if ($array["country"] =="Ghana") echo "selected";?> value="Ghana"></option>
  535. <option <?php if ($array["country"] =="Gibraltar") echo "selected";?> value="Gibraltar"></option>
  536. <option <?php if ($array["country"] =="Greece") echo "selected";?> value="Greece"></option>
  537. <option <?php if ($array["country"] =="Greenland") echo "selected";?> value="Greenland"></option>
  538. <option <?php if ($array["country"] =="Grenada") echo "selected";?> value="Grenada"></option>
  539. <option <?php if ($array["country"] =="Guam") echo "selected";?> value="Guam"></option>
  540. <option <?php if ($array["country"] =="Guatemala") echo "selected";?> value="Guatemala"></option>
  541. <option <?php if ($array["country"] =="Guernsey") echo "selected";?> value="Guernsey"></option>
  542. <option <?php if ($array["country"] =="Guinea") echo "selected";?> value="Guinea"></option>
  543. <option <?php if ($array["country"] =="Guinea Bissau") echo "selected";?> value="Guinea Bissau"></option>
  544. <option <?php if ($array["country"] =="Guyana") echo "selected";?> value="Guyana"></option>
  545. <option <?php if ($array["country"] =="Haiti") echo "selected";?> value="Haiti"></option>
  546. <option <?php if ($array["country"] =="Honduras") echo "selected";?> value="Honduras"></option>
  547. <option <?php if ($array["country"] =="Hong Kong") echo "selected";?> value="Hong Kong"></option>
  548. <option <?php if ($array["country"] =="Hungary") echo "selected";?> value="Hungary"></option>
  549. <option <?php if ($array["country"] =="Iceland") echo "selected";?> value="Iceland"></option>
  550. <option <?php if ($array["country"] =="India") echo "selected";?> value="India"></option>
  551. <option <?php if ($array["country"] =="Indonesia") echo "selected";?> value="Indonesia"></option>
  552. <option <?php if ($array["country"] =="Iran") echo "selected";?> value="Iran"></option>
  553. <option <?php if ($array["country"] =="Iraq") echo "selected";?> value="Iraq"></option>
  554. <option <?php if ($array["country"] =="Ireland") echo "selected";?> value="Ireland"></option>
  555. <option <?php if ($array["country"] =="Isle of Man") echo "selected";?> value="Isle of Man"></option>
  556. <option <?php if ($array["country"] =="Israel") echo "selected";?> value="Israel"></option>
  557. <option <?php if ($array["country"] =="Italy") echo "selected";?> value="Italy"></option>
  558. <option <?php if ($array["country"] =="Jamaica") echo "selected";?> value="Jamaica"></option>
  559. <option <?php if ($array["country"] =="Japan") echo "selected";?> value="Japan"></option>
  560. <option <?php if ($array["country"] =="Jersey") echo "selected";?> value="Jersey"></option>
  561. <option <?php if ($array["country"] =="Jordan") echo "selected";?> value="Jordan"></option>
  562. <option <?php if ($array["country"] =="Kazakhstan") echo "selected";?> value="Kazakhstan"></option>
  563. <option <?php if ($array["country"] =="Kenya") echo "selected";?> value="Kenya"></option>
  564. <option <?php if ($array["country"] =="Kiribati") echo "selected";?> value="Kiribati"></option>
  565. <option <?php if ($array["country"] =="Kosovo") echo "selected";?> value="Kosovo"></option>
  566. <option <?php if ($array["country"] =="Kuwait") echo "selected";?> value="Kuwait"></option>
  567. <option <?php if ($array["country"] =="Kyrgyzstan") echo "selected";?> value="Kyrgyzstan"></option>
  568. <option <?php if ($array["country"] =="Laos") echo "selected";?> value="Laos"></option>
  569. <option <?php if ($array["country"] =="Latvia") echo "selected";?> value="Latvia"></option>
  570. <option <?php if ($array["country"] =="Lebanon") echo "selected";?> value="Lebanon"></option>
  571. <option <?php if ($array["country"] =="Lesotho") echo "selected";?> value="Lesotho"></option>
  572. <option <?php if ($array["country"] =="Liberia") echo "selected";?> value="Liberia"></option>
  573. <option <?php if ($array["country"] =="Libya") echo "selected";?> value="Libya"></option>
  574. <option <?php if ($array["country"] =="Liechtenstein") echo "selected";?> value="Liechtenstein"></option>
  575. <option <?php if ($array["country"] =="Lithuania") echo "selected";?> value="Lithuania"></option>
  576. <option <?php if ($array["country"] =="Luxembourg") echo "selected";?> value="Luxembourg"></option>
  577. <option <?php if ($array["country"] =="Macau") echo "selected";?> value="Macau"></option>
  578. <option <?php if ($array["country"] =="Macedonia") echo "selected";?> value="Macedonia"></option>
  579. <option <?php if ($array["country"] =="Madagascar") echo "selected";?> value="Madagascar"></option>
  580. <option <?php if ($array["country"] =="Malawi") echo "selected";?> value="Malawi"></option>
  581. <option <?php if ($array["country"] =="Malaysia") echo "selected";?> value="Malaysia"></option>
  582. <option <?php if ($array["country"] =="Maldives") echo "selected";?> value="Maldives"></option>
  583. <option <?php if ($array["country"] =="Mali") echo "selected";?> value="Mali"></option>
  584. <option <?php if ($array["country"] =="Malta") echo "selected";?> value="Malta"></option>
  585. <option <?php if ($array["country"] =="Marshall Islands") echo "selected";?> value="Marshall Islands"></option>
  586. <option <?php if ($array["country"] =="Mauritania") echo "selected";?> value="Mauritania"></option>
  587. <option <?php if ($array["country"] =="Mauritius") echo "selected";?> value="Mauritius"></option>
  588. <option <?php if ($array["country"] =="Mexico") echo "selected";?> value="Mexico"></option>
  589. <option <?php if ($array["country"] =="Micronesia") echo "selected";?> value="Micronesia"></option>
  590. <option <?php if ($array["country"] =="Moldova") echo "selected";?> value="Moldova"></option>
  591. <option <?php if ($array["country"] =="Monaco") echo "selected";?> value="Monaco"></option>
  592. <option <?php if ($array["country"] =="Mongolia") echo "selected";?> value="Mongolia"></option>
  593. <option <?php if ($array["country"] =="Montenegro") echo "selected";?> value="Montenegro"></option>
  594. <option <?php if ($array["country"] =="Montserrat") echo "selected";?> value="Montserrat"></option>
  595. <option <?php if ($array["country"] =="Morocco") echo "selected";?> value="Morocco"></option>
  596. <option <?php if ($array["country"] =="Mozambique") echo "selected";?> value="Mozambique"></option>
  597. <option <?php if ($array["country"] =="Myanmar") echo "selected";?> value="Myanmar"></option>
  598. <option <?php if ($array["country"] =="Namibia") echo "selected";?> value="Namibia"></option>
  599. <option <?php if ($array["country"] =="Nauro") echo "selected";?> value="Nauro"></option>
  600. <option <?php if ($array["country"] =="Nepal") echo "selected";?> value="Nepal"></option>
  601. <option <?php if ($array["country"] =="Netherlands") echo "selected";?> value="Netherlands"></option>
  602. <option <?php if ($array["country"] =="Netherlands Antilles") echo "selected";?> value="Netherlands Antilles"></option>
  603. <option <?php if ($array["country"] =="New Caledonia") echo "selected";?> value="New Caledonia"></option>
  604. <option <?php if ($array["country"] =="New Zealand") echo "selected";?> value="New Zealand"></option>
  605. <option <?php if ($array["country"] =="Nicaragua") echo "selected";?> value="Nicaragua"></option>
  606. <option <?php if ($array["country"] =="Niger") echo "selected";?> value="Niger"></option>
  607. <option <?php if ($array["country"] =="Nigeria") echo "selected";?> value="Nigeria"></option>
  608. <option <?php if ($array["country"] =="North Korea") echo "selected";?> value="North Korea"></option>
  609. <option <?php if ($array["country"] =="Norway") echo "selected";?> value="Norway"></option>
  610. <option <?php if ($array["country"] =="Oman") echo "selected";?> value="Oman"></option>
  611. <option <?php if ($array["country"] =="Pakistan") echo "selected";?> value="Pakistan"></option>
  612. <option <?php if ($array["country"] =="Palau") echo "selected";?> value="Palau"></option>
  613. <option <?php if ($array["country"] =="Palestine") echo "selected";?> value="Palestine"></option>
  614. <option <?php if ($array["country"] =="Panama") echo "selected";?> value="Panama"></option>
  615. <option <?php if ($array["country"] =="Papua New Guinea") echo "selected";?> value="Papua New Guinea"></option>
  616. <option <?php if ($array["country"] =="Paraguay") echo "selected";?> value="Paraguay"></option>
  617. <option <?php if ($array["country"] =="Peru") echo "selected";?> value="Peru"></option>
  618. <option <?php if ($array["country"] =="Philippines") echo "selected";?> value="Philippines"></option>
  619. <option <?php if ($array["country"] =="Poland") echo "selected";?> value="Poland"></option>
  620. <option <?php if ($array["country"] =="Portugal") echo "selected";?> value="Portugal"></option>
  621. <option <?php if ($array["country"] =="Puerto Rico") echo "selected";?> value="Puerto Rico"></option>
  622. <option <?php if ($array["country"] =="Qatar") echo "selected";?> value="Qatar"></option>
  623. <option <?php if ($array["country"] =="Reunion") echo "selected";?> value="Reunion"></option>
  624. <option <?php if ($array["country"] =="Romania") echo "selected";?> value="Romania"></option>
  625. <option <?php if ($array["country"] =="Russia") echo "selected";?> value="Russia"></option>
  626. <option <?php if ($array["country"] =="Rwanda") echo "selected";?> value="Rwanda"></option>
  627. <option <?php if ($array["country"] =="Saint Pierre & Miquelon") echo "selected";?> value="Saint Pierre & Miquelon"></option>
  628. <option <?php if ($array["country"] =="Samoa") echo "selected";?> value="Samoa"></option>
  629. <option <?php if ($array["country"] =="San Marino") echo "selected";?> value="San Marino"></option>
  630. <option <?php if ($array["country"] =="Sao Tome and Principe") echo "selected";?> value="Sao Tome and Principe"></option>
  631. <option <?php if ($array["country"] =="Saudi Arabia") echo "selected";?> value="Saudi Arabia"></option>
  632. <option <?php if ($array["country"] =="Senegal") echo "selected";?> value="Senegal"></option>
  633. <option <?php if ($array["country"] =="Serbia") echo "selected";?> value="Serbia"></option>
  634. <option <?php if ($array["country"] =="Seychelles") echo "selected";?> value="Seychelles"></option>
  635. <option <?php if ($array["country"] =="Sierra Leone") echo "selected";?> value="Sierra Leone"></option>
  636. <option <?php if ($array["country"] =="Singapore") echo "selected";?> value="Singapore"></option>
  637. <option <?php if ($array["country"] =="Slovakia") echo "selected";?> value="Slovakia"></option>
  638. <option <?php if ($array["country"] =="Slovenia") echo "selected";?> value="Slovenia"></option>
  639. <option <?php if ($array["country"] =="Solomon Islands") echo "selected";?> value="Solomon Islands"></option>
  640. <option <?php if ($array["country"] =="Somalia") echo "selected";?> value="Somalia"></option>
  641. <option <?php if ($array["country"] =="South Africa") echo "selected";?> value="South Africa"></option>
  642. <option <?php if ($array["country"] =="South Korea") echo "selected";?> value="South Korea"></option>
  643. <option <?php if ($array["country"] =="South Sudan") echo "selected";?> value="South Sudan"></option>
  644. <option <?php if ($array["country"] =="Spain") echo "selected";?> value="Spain"></option>
  645. <option <?php if ($array["country"] =="Sri Lanka") echo "selected";?> value="Sri Lanka"></option>
  646. <option <?php if ($array["country"] =="St Kitts & Nevis") echo "selected";?> value="St Kitts & Nevis"></option>
  647. <option <?php if ($array["country"] =="St Lucia") echo "selected";?> value="St Lucia"></option>
  648. <option <?php if ($array["country"] =="St Vincent") echo "selected";?> value="St Vincent"></option>
  649. <option <?php if ($array["country"] =="Sudan") echo "selected";?> value="Sudan"></option>
  650. <option <?php if ($array["country"] =="Suriname") echo "selected";?> value="Suriname"></option>
  651. <option <?php if ($array["country"] =="Swaziland") echo "selected";?> value="Swaziland"></option>
  652. <option <?php if ($array["country"] =="Sweden") echo "selected";?> value="Sweden"></option>
  653. <option <?php if ($array["country"] =="Switzerland") echo "selected";?> value="Switzerland"></option>
  654. <option <?php if ($array["country"] =="Syria") echo "selected";?> value="Syria"></option>
  655. <option <?php if ($array["country"] =="Taiwan") echo "selected";?> value="Taiwan"></option>
  656. <option <?php if ($array["country"] =="Tajikistan") echo "selected";?> value="Tajikistan"></option>
  657. <option <?php if ($array["country"] =="Tanzania") echo "selected";?> value="Tanzania"></option>
  658. <option <?php if ($array["country"] =="Thailand") echo "selected";?> value="Thailand"></option>
  659. <option <?php if ($array["country"] =="Timor L'Este") echo "selected";?> value="Timor L'Este"></option>
  660. <option <?php if ($array["country"] =="Togo") echo "selected";?> value="Togo"></option>
  661. <option <?php if ($array["country"] =="Tonga") echo "selected";?> value="Tonga"></option>
  662. <option <?php if ($array["country"] =="Trinidad & Tobago") echo "selected";?> value="Trinidad & Tobago"></option>
  663. <option <?php if ($array["country"] =="Tunisia") echo "selected";?> value="Tunisia"></option>
  664. <option <?php if ($array["country"] =="Turkey") echo "selected";?> value="Turkey"></option>
  665. <option <?php if ($array["country"] =="Turkmenistan") echo "selected";?> value="Turkmenistan"></option>
  666. <option <?php if ($array["country"] =="Turks & Caicos") echo "selected";?> value="Turks & Caicos"></option>
  667. <option <?php if ($array["country"] =="Tuvalu") echo "selected";?> value="Tuvalu"></option>
  668. <option <?php if ($array["country"] =="Uganda") echo "selected";?> value="Uganda"></option>
  669. <option <?php if ($array["country"] =="Ukraine") echo "selected";?> value="Ukraine"></option>
  670. <option <?php if ($array["country"] =="United Arab Emirates") echo "selected";?> value="United Arab Emirates"></option>
  671. <option <?php if ($array["country"] =="United Kingdom") echo "selected";?> value="United Kingdom"></option>
  672. <option <?php if ($array["country"] =="United States of America - USA") echo "selected";?> value="United States of America - USA"></option>
  673. <option <?php if ($array["country"] =="Uruguay") echo "selected";?> value="Uruguay"></option>
  674. <option <?php if ($array["country"] =="Uzbekistan") echo "selected";?> value="Uzbekistan"></option>
  675. <option <?php if ($array["country"] =="Vanuatu") echo "selected";?> value="Vanuatu"></option>
  676. <option <?php if ($array["country"] =="Vatican City") echo "selected";?> value="Vatican City"></option>
  677. <option <?php if ($array["country"] =="Venezuela") echo "selected";?> value="Venezuela"></option>
  678. <option <?php if ($array["country"] =="Vietnam") echo "selected";?> value="Vietnam"></option>
  679. <option <?php if ($array["country"] =="Virgin Islands (US)") echo "selected";?> value="Virgin Islands (US)"></option>
  680. <option <?php if ($array["country"] =="Yemen") echo "selected";?> value="Yemen"></option>
  681. <option <?php if ($array["country"] =="Zambia") echo "selected";?> value="Zambia"></option>
  682. <option <?php if ($array["country"] =="Zimbabwe") echo "selected";?> value="Zimbabwe"></option>
  683. </datalist>
  684. </div>
  685. <!-- Permanent Street Address 1 Input -->
  686. <div class="form-group">
  687. <label for="csa1Input">Street Address 1<span class="error"> * <?=$sadd1Err?></span></label>
  688. <input type="text" class="form-control" name="sadd1" id="sadd1" value="<?=$array["psadd1"]?>" data-toggle="tooltip" title="Enter the Street of your permanent address" placeholder="Enter Street Address">
  689. </div>
  690. <!-- Permanent Street Address 2 Input -->
  691. <div class="form-group">
  692. <label for="sa2Input">Street Address 2</label>
  693. <input type="text" class="form-control" name="sadd2" id="sadd2" value="<?=$array["psadd2"]?>" data-toggle="tooltip" title="Use this line if your address is longer than Street Address 1 Field" placeholder="Continue Street Address">
  694. </div>
  695. <!-- Permanent City Input -->
  696. <div class="form-group">
  697. <label for="cityInput">City<span class="error"> * <?=$pcityErr?></span></label>
  698. <input type="text" class="form-control" name="pcity" id="pcity" value="<?=$array["pcity"]?>" data-toggle="tooltip" title="Enter the City, Town, or Village of your permanent address" placeholder="Enter City, Town, or Village Name">
  699. </div>
  700. <!-- US State Select -->
  701. <div class="form-group">
  702. <label for="pstateSelect">State<span class="error"> * <?=$pstateErr?></span></label>
  703. <select class="custom-select mb-4 mr-sm-4 mb-sm-2" name="pstateSelect" data-toggle="tooltip" title="Select your permanent State of residence from the dropdown list">
  704. <option value="">Choose State...</option>
  705. <option <?php if ($array["pstate"] == "1") echo "selected";?> value="1">Alabama</option>
  706. <option <?php if ($array["pstate"] =="2") echo "selected";?> value="2">Alaska</option>
  707. <option <?php if ($array["pstate"] =="3") echo "selected";?> value="3">Arizona</option>
  708. <option <?php if ($array["pstate"] =="4") echo "selected";?> value="4">Arkansas</option>
  709. <option <?php if ($array["pstate"] =="5") echo "selected";?> value="5">California</option>
  710. <option <?php if ($array["pstate"] =="6") echo "selected";?> value="6">Colorado</option>
  711. <option <?php if ($array["pstate"] =="7") echo "selected";?> value="7">Connecticut</option>
  712. <option <?php if ($array["pstate"] == "8") echo "selected";?> value="8">Delaware</option>
  713. <option <?php if ($array["pstate"] == "9") echo "selected";?> value="9">Florida</option>
  714. <option <?php if ($array["pstate"] == "10") echo "selected";?> value="10">Georgia</option>
  715. <option <?php if ($array["pstate"] == "11") echo "selected";?> value="11">Hawaii</option>
  716. <option <?php if ($array["pstate"] == "12") echo "selected";?> value="12">Idaho</option>
  717. <option <?php if ($array["pstate"] == "13") echo "selected";?> value="13">Illinois</option>
  718. <option <?php if ($array["pstate"] == "14") echo "selected";?> value="14">Indiana</option>
  719. <option <?php if ($array["pstate"] == "15") echo "selected";?> value="15">Iowa</option>
  720. <option <?php if ($array["pstate"] == "16") echo "selected";?> value="16">Kansas</option>
  721. <option <?php if ($array["pstate"] == "17") echo "selected";?> value="17">Kentucky</option>
  722. <option <?php if ($array["pstate"] == "18") echo "selected";?> value="18">Louisiana</option>
  723. <option <?php if ($array["pstate"] == "19") echo "selected";?> value="19">Maine</option>
  724. <option <?php if ($array["pstate"] == "20") echo "selected";?> value="20">Maryland</option>
  725. <option <?php if ($array["pstate"] == "21") echo "selected";?> value="21">Massachusetts</option>
  726. <option <?php if ($array["pstate"] == "22") echo "selected";?> value="22">Michigan</option>
  727. <option <?php if ($array["pstate"] == "23") echo "selected";?> value="23">Minnesota</option>
  728. <option <?php if ($array["pstate"] == "24") echo "selected";?> value="24">Mississippi</option>
  729. <option <?php if ($array["pstate"] == "25") echo "selected";?> value="25">Missouri</option>
  730. <option <?php if ($array["pstate"] == "26") echo "selected";?> value="26">Montana</option>
  731. <option <?php if ($array["pstate"] == "27") echo "selected";?> value="27">Nebraska</option>
  732. <option <?php if ($array["pstate"] == "28") echo "selected";?> value="28">Nevada</option>
  733. <option <?php if ($array["pstate"] == "29") echo "selected";?> value="29">New Hampshire</option>
  734. <option <?php if ($array["pstate"] == "30") echo "selected";?> value="30">New Jersey</option>
  735. <option <?php if ($array["pstate"] == "31") echo "selected";?> value="31">New Mexico</option>
  736. <option <?php if ($array["pstate"] == "32") echo "selected";?> value="32">New York</option>
  737. <option <?php if ($array["pstate"] == "33") echo "selected";?> value="33">North Carolina</option>
  738. <option <?php if ($array["pstate"] == "34") echo "selected";?> value="34">North Dakota</option>
  739. <option <?php if ($array["pstate"] == "35") echo "selected";?> value="35">Ohio</option>
  740. <option <?php if ($array["pstate"] == "36") echo "selected";?> value="36">Oklahoma</option>
  741. <option <?php if ($array["pstate"] == "37") echo "selected";?> value="37">Oregon</option>
  742. <option <?php if ($array["pstate"] == "38") echo "selected";?> value="38">Pennsylvania</option>
  743. <option <?php if ($array["pstate"] == "39") echo "selected";?> value="39">Rhode Island</option>
  744. <option <?php if ($array["pstate"] == "40") echo "selected";?> value="40">South Carolina</option>
  745. <option <?php if ($array["pstate"] == "41") echo "selected";?> value="41">South Dakota</option>
  746. <option <?php if ($array["pstate"] == "42") echo "selected";?> value="42">Tennessee</option>
  747. <option <?php if ($array["pstate"] == "43") echo "selected";?> value="43">Texas</option>
  748. <option <?php if ($array["pstate"] == "44") echo "selected";?> value="44">Utah</option>
  749. <option <?php if ($array["pstate"] == "45") echo "selected";?> value="45">Vermont</option>
  750. <option <?php if ($array["pstate"] == "46") echo "selected";?> value="46">Virginia</option>
  751. <option <?php if ($array["pstate"] == "47") echo "selected";?> value="47">Washington</option>
  752. <option <?php if ($array["pstate"] == "48") echo "selected";?> value="48">West Virginia</option>
  753. <option <?php if ($array["pstate"] == "49") echo "selected";?> value="49">Wisconsin</option>
  754. <option <?php if ($array["pstate"] == "50") echo "selected";?> value="50">Wyoming</option>
  755. </select>
  756. </div>
  757. <!-- Permanent Zipcode Input -->
  758. <div class="form-group">
  759. <label for="zipInput">Zipcode<span class="error"> * <?=$pzipErr?></span></label>
  760. <input type="text" class="form-control" name="pzip" id="pzip" value="<?=$array["pzip"]?>" data-toggle="tooltip" title="Enter the Postal Zipcode of your permanent address" placeholder="Enter Postal Zipcode" pattern="\d{5}" maxlength="5">
  761. </div>
  762. </fieldset>
  763. <!-- End Permanent Address information -->
  764.  
  765. <!-- Local Address information -->
  766. <fieldset class="form-group">
  767. <!-- Local Street Address 1 Input -->
  768. <legend>Local Address</legend>
  769. <div class="form-group">
  770. <label for="lsa1Input">Street Address 1</label>
  771. <input type="text" class="form-control" name="lsadd1" id="lsadd1" value="<?=$array["lsadd1"]?>" data-toggle="tooltip" title="Enter the Street Address of your local address" placeholder="Enter Street Address">
  772. </div>
  773. <!-- Local Street Address 2 Input -->
  774. <div class="form-group">
  775. <label for="lsa2Input">Street Address 2</label>
  776. <input type="text" class="form-control" name="lsadd2" id="lsadd2" value="<?=$array["lsadd2"]?>" data-toggle="tooltip" title="Use this line if your address is longer than Street Address 1 of your local address" placeholder="Continue Street Address">
  777. </div>
  778. <!-- Local City Input -->
  779. <div class="form-group">
  780. <label for="lcityInput">City</label>
  781. <input type="text" class="form-control" name="lcity" id="lcity" value="<?=$array["lcity"]?>" data-toggle="tooltip" title="Enter the City of your local address" placeholder="Enter City">
  782. </div>
  783. <!-- US State Select -->
  784. <div class="form-group">
  785. <label for="lstateSelect">State</label>
  786. <select class="custom-select mb-4 mr-sm-4 mb-sm-2" name="lstateSelect" data-toggle="tooltip" title="Select your local State of residence from the dropdown list">
  787. <option value="">Choose State...</option>
  788. <option <?php if ($array["lstate"] == "1") echo "selected";?> value="1">Alabama</option>
  789. <option <?php if ($array["lstate"] == "2") echo "selected";?> value="2">Alaska</option>
  790. <option <?php if ($array["lstate"] == "3") echo "selected";?> value="3">Arizona</option>
  791. <option <?php if ($array["lstate"] == "4") echo "selected";?> value="4">Arkansas</option>
  792. <option <?php if ($array["lstate"] == "5") echo "selected";?> value="5">California</option>
  793. <option <?php if ($array["lstate"] == "6") echo "selected";?> value="6">Colorado</option>
  794. <option <?php if ($array["lstate"] == "7") echo "selected";?> value="7">Connecticut</option>
  795. <option <?php if ($array["lstate"] == "8") echo "selected";?> value="8">Delaware</option>
  796. <option <?php if ($array["lstate"] == "9") echo "selected";?> value="9">Florida</option>
  797. <option <?php if ($array["lstate"] == "10") echo "selected";?> value="10">Georgia</option>
  798. <option <?php if ($array["lstate"] == "11") echo "selected";?> value="11">Hawaii</option>
  799. <option <?php if ($array["lstate"] == "12") echo "selected";?> value="12">Idaho</option>
  800. <option <?php if ($array["lstate"] == "13") echo "selected";?> value="13">Illinois</option>
  801. <option <?php if ($array["lstate"] == "14") echo "selected";?> value="14">Indiana</option>
  802. <option <?php if ($array["lstate"] == "15") echo "selected";?> value="15">Iowa</option>
  803. <option <?php if ($array["lstate"] == "16") echo "selected";?> value="16">Kansas</option>
  804. <option <?php if ($array["lstate"] == "17") echo "selected";?> value="17">Kentucky</option>
  805. <option <?php if ($array["lstate"] == "18") echo "selected";?> value="18">Louisiana</option>
  806. <option <?php if ($array["lstate"] == "19") echo "selected";?> value="19">Maine</option>
  807. <option <?php if ($array["lstate"] == "20") echo "selected";?> value="20">Maryland</option>
  808. <option <?php if ($array["lstate"] == "21") echo "selected";?> value="21">Massachusetts</option>
  809. <option <?php if ($array["lstate"] == "22") echo "selected";?> value="22">Michigan</option>
  810. <option <?php if ($array["lstate"] == "23") echo "selected";?> value="23">Minnesota</option>
  811. <option <?php if ($array["lstate"] == "24") echo "selected";?> value="24">Mississippi</option>
  812. <option <?php if ($array["lstate"] == "25") echo "selected";?> value="25">Missouri</option>
  813. <option <?php if ($array["lstate"] == "26") echo "selected";?> value="26">Montana</option>
  814. <option <?php if ($array["lstate"] == "27") echo "selected";?> value="27">Nebraska</option>
  815. <option <?php if ($array["lstate"] == "28") echo "selected";?> value="28">Nevada</option>
  816. <option <?php if ($array["lstate"] == "29") echo "selected";?> value="29">New Hampshire</option>
  817. <option <?php if ($array["lstate"] == "30") echo "selected";?> value="30">New Jersey</option>
  818. <option <?php if ($array["lstate"] == "31") echo "selected";?> value="31">New Mexico</option>
  819. <option <?php if ($array["lstate"] == "32") echo "selected";?> value="32">New York</option>
  820. <option <?php if ($array["lstate"] == "33") echo "selected";?> value="33">North Carolina</option>
  821. <option <?php if ($array["lstate"] == "34") echo "selected";?> value="34">North Dakota</option>
  822. <option <?php if ($array["lstate"] == "35") echo "selected";?> value="35">Ohio</option>
  823. <option <?php if ($array["lstate"] == "36") echo "selected";?> value="36">Oklahoma</option>
  824. <option <?php if ($array["lstate"] == "37") echo "selected";?> value="37">Oregon</option>
  825. <option <?php if ($array["lstate"] == "38") echo "selected";?> value="38">Pennsylvania</option>
  826. <option <?php if ($array["lstate"] == "39") echo "selected";?> value="39">Rhode Island</option>
  827. <option <?php if ($array["lstate"] == "40") echo "selected";?> value="40">South Carolina</option>
  828. <option <?php if ($array["lstate"] == "41") echo "selected";?> value="41">South Dakota</option>
  829. <option <?php if ($array["lstate"] == "42") echo "selected";?> value="42">Tennessee</option>
  830. <option <?php if ($array["lstate"] == "43") echo "selected";?> value="43">Texas</option>
  831. <option <?php if ($array["lstate"] == "44") echo "selected";?> value="44">Utah</option>
  832. <option <?php if ($array["lstate"] == "45") echo "selected";?> value="45">Vermont</option>
  833. <option <?php if ($array["lstate"] == "46") echo "selected";?> value="46">Virginia</option>
  834. <option <?php if ($array["lstate"] == "47") echo "selected";?> value="47">Washington</option>
  835. <option <?php if ($array["lstate"] == "48") echo "selected";?> value="48">West Virginia</option>
  836. <option <?php if ($array["lstate"] == "49") echo "selected";?> value="49">Wisconsin</option>
  837. <option <?php if ($array["lstate"] == "50") echo "selected";?> value="50">Wyoming</option>
  838. </select>
  839. </div>
  840. <!-- Local Zipcode Input -->
  841. <div class="form-group">
  842. <label for="lzipInput">Zipcode</label>
  843. <input type="text" class="form-control" name="lzip" id="lzip" value="<?=$array["lzip"]?>" data-toggle="tooltip" title="Example US Zipcode: 12345" data-toggle="tooltip" title="Enter the Postal Zipcode of your local address" placeholder="Enter 5-Digit Zipcode" pattern="\d{5}" maxlength="5">
  844. </div>
  845. </fieldset>
  846. <!-- Local Address information -->
  847.  
  848. <!-- citizenshipship Status -->
  849. <fieldset class ="form-group">
  850. <legend data-toggle="tooltip" title="Choose your citizenshipship status">Citizenship Status<span class="error"> * <?=$citizenshipErr?></span></legend>
  851. <a href="http://www.tnstate.edu/diversity/internationalstudent-FAQs.aspx" target="_blank">Need Help? Check out TSU International Students Facts</a> <br><br>
  852. <div class="form-check">
  853. <label class="form-check-label"><input type="radio" class="form-check-input" name="citizenship" id="citizenshipRadio1" data-toggle="tooltip" title="An individual who is not a U.S. citizenship or US National" <?php if ($array["citizenshipship"] == "noncitizenship") echo "checked"; ?> value="noncitizenship"> Not US citizenship
  854. </label>
  855. </div>
  856. <div class="form-check">
  857. <label class="form-check-label"><input type="radio" class="form-check-input" name="citizenship" id="citizenshipRadio2" data-toggle="tooltip" title="A person is a United States citizenship by birth or by naturalization. Persons (except for the children of foreign diplomatic staff) who are born in the 50 states, the District of Columbia, and in most cases, Puerto Rico (PR), the U.S. Virgin Islands (VI), Guam (GU), and the Northern Marianna Islands (MP) are U.S. citizenships, as are most persons born abroad to parents (or a parent) who are citizenships. All U.S. citizenships are considered to be U.S. nationals, but not all nationals are citizenships: natives of American Samoa and Swain’s Island (AS) are not U.S. citizenships but are nationals." <?php if ($array["citizenshipship"] == "citizenship") echo "checked"; ?> value="citizenship"> US citizenship
  858. </label>
  859. </div>
  860. <div class="form-check">
  861. <label class="form-check-label"><input type="radio" class="form-check-input" name="citizenship" id="citizenshipRadio3" data-toggle="tooltip" title="If you are in the U.S. on:
  862. A F1 or F2 student visa, or
  863. A J1 or J2 exchange visitor visa, or
  864. A G series visa (pertaining to international organizations), or
  865. Other categories not included under U.S. citizenship and eligible noncitizenship" <?php if ($array["citizenshipship"] == "other") echo "checked"; ?> value="other"> Other
  866. </label>
  867. </div><br>
  868. <!-- SSN Input -->
  869. <div class="form-group" id="ssnForm">
  870. <label for="ssnForm">SSN<span class="error"> * <?=$ssnErr?></span></label>
  871. <input type="text" name="ssn" id="ssn" value="<?=$ssn_masked?>" data-toggle="tooltip" title="US SSN format: ###-##-####" placeholder="Enter 9-Digit US Social Security Number (SSN)" pattern="###-##-\d{4}" class="form-control" maxlength="11" onBlur="modifyssn(this.value)">
  872. </div>
  873. <div>
  874. <input type="hidden" name="ssn_value" id="ssn_value" value="">
  875. </div>
  876. </fieldset>
  877. <!-- End citizenshipship Status -->
  878.  
  879. <!--Demographics Information-->
  880. <legend>Demographics</legend>
  881. <div class="form-group">
  882. <label for="raceSelect">Race</label>
  883. <select class="custom-select mb-4 mr-sm-4 mb-sm-2" data-toggle="tooltip" title="Select your Race from the dropdown list" name="raceSelect">
  884. <option value="">Choose...</option>
  885. <option <?php if ($array["race"] == "Alaskan Native") echo "selected";?> value="Alaskan Native">Alaskan Native</option>
  886. <option <?php if ($array["race"] == "American Indian or Native American") echo "selected";?> value="American Indian or Native American">American Indian or Native American</option>
  887. <option <?php if ($array["race"] == "Asian") echo "selected";?> value="Asian">Asian</option>
  888. <option <?php if ($array["race"] == "Black or African American") echo "selected";?> value="Black or African American">Black or African American</option>
  889. <option <?php if ($array["race"] == "Hawaiian Native or Pacific Islander") echo "selected";?> value="Hawaiian Native or Pacific Islander">Hawaiian Native or Pacific Islander</option>
  890. <option <?php if ($array["race"] == "White or Caucasian") echo "selected";?> value="White or Caucasian">White or Caucasian</option>
  891. </select>
  892. </div>
  893. <!-- Marital Status Select -->
  894. <div class="form-group">
  895. <label for="maritalSelect">Marital Status</label>
  896. <select class="custom-select mb-4 mr-sm-4 mb-sm-2" name="maritalSelect" id="maritalSelect" data-toggle="tooltip" title="Select your Marital Status from the dropdown list">
  897. <option value="">Choose...</option>
  898. <option <?php if ($array["maritalstatus"] == "Single") echo "selected";?> value="Single">Single</option>
  899. <option <?php if ($array["maritalstatus"] == "Married") echo "selected";?> value="Married">Married</option>
  900. <option <?php if ($array["maritalstatus"] == "Separated") echo "selected";?> value="Separated">Separated</option>
  901. <option <?php if ($array["maritalstatus"] == "Divorced") echo "selected";?> value="Divorced">Divorced</option>
  902. <option <?php if ($array["maritalstatus"] == "Widowed") echo "selected";?> value="Widowed">Widowed</option>
  903. </select>
  904. </div>
  905. <fieldset class="form-group">
  906. <fieldset class ="form-group" data-toggle="tooltip" title="Select your ethnicity">
  907. <legend>Ethnicity</legend>
  908. <!-- Ethnicity Radio Buttons -->
  909. <div class="form-check">
  910. <label class="form-check-label">
  911. <input type="radio" class="form-check-input" name="ethnicity" id="ethnicityRadios1" <?php if ($array["ethnicity"] == "Hispanic or Latino") echo "checked";?> value="Hispanic or Latino"> Hispanic or Latino
  912. </label>
  913. </div>
  914. <div class="form-check">
  915. <label class="form-check-label">
  916. <input type="radio" class="form-check-input" name="ethnicity" id="ethnicityRadios2" <?php if ($array["ethnicity"] == "Not Hispanic or Latino
  917. </label> ") echo "checked";?> value="Not Hispanic or Latino
  918. </label> "> Not Hispanic or Latino
  919. </label>
  920. </div>
  921. </fieldset>
  922. <fieldset class="form-group" data-toggle="tooltip" title="Select your Gender">
  923. <legend>Gender</legend>
  924. <!-- Gender Radio Buttons -->
  925. <div class="form-check">
  926. <label class="form-check-label">
  927. <input type="radio" class="form-check-input" name="gender" id="genderRadios1" <?php if ($array["gender"] == "Male") echo "checked";?> value="Male"> Male
  928. </label>
  929. </div>
  930. <div class="form-check">
  931. <label class="form-check-label">
  932. <input type="radio" class="form-check-input" name="gender" id="genderRadios2" <?php if ($array["gender"] == "Female") echo "checked";?> value="Female"> Female
  933. </label>
  934. </div>
  935. </fieldset>
  936.  
  937. <button type="submit" id="save" name="save" class="btn btn-primary">Save</button>
  938. <a href="home.php" id="cancel" name="cancel" type="button" class="btn btn-danger">Exit</a>
  939. </fieldset>
  940. </form>
  941. </div><!-- end card -->
  942. </section>
  943. </body>
  944.  
  945. </html>
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