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  1. <!DOCTYPE html>
  2. <html>
  3. <head>
  4. <title>UAS-NO_2</title>
  5. <style type="text/css">
  6. .wrap{
  7. width:100%;
  8. }
  9. .wrap .header{
  10. background-color: red;
  11. height: 200px;
  12. }
  13. .wrap .header .logo{
  14. background: white;
  15. float: left;
  16. width: 200px;
  17. height: 200px;
  18. }
  19. .wrap .header .word{
  20. text-align: center;
  21. padding: 20px 10px 31px 100px;
  22. color: white;
  23. font-size: 20px;
  24. }
  25. .content{
  26. height: 100%;
  27. background-color: blue;
  28. padding: 10px 10px 10px 10px;
  29. }
  30. .content form{
  31. color: white;
  32. margin: 13px 10px 10px 390px;
  33. width: 100%;
  34.  
  35. }
  36. .content h1{
  37. text-align: center;
  38. color: white;
  39. }
  40. .button{
  41. padding: 10px 10px 10px 10px;
  42. }
  43.  
  44. </style>
  45. </head>
  46. <body>
  47. <div class="wrap">
  48. <div class="header">
  49. <div class="logo">
  50. <img src="logo_UPH.gif" width="100%" height="100%">
  51. </div>
  52. <div class="word">
  53. <h1>UNIVERSITAS PELITA HARAPAN<br>KAMPUS MEDAN</br></h1>
  54. </div>
  55. </div>
  56. <div class="content">
  57. <h1>Pendaftaran Mahasiswa Baru</h1>
  58. <form class="form">
  59. <table>
  60. <tr>
  61. <td>Nama</td>
  62. <td></td>
  63. <td>:</td>
  64. <td><input id="NamaDepan" type="nama"></td>
  65. </tr>
  66. <tr>
  67. <td>Alamat</td>
  68. <td> </td>
  69. <td>:</td>
  70. <td><input id="NamaBlkg" type="alamat"></td>
  71. </tr>
  72. <tr>
  73. <td>Tempat dan Tanggal Lahir</td>
  74. <td></td>
  75. <td>:</td>
  76. <td>
  77. <input id="tmpttgll" type="tempattanggallahir">
  78. <select name="Tanggal Lahir">
  79. <option name="Tgl">Tgl </option>
  80. <option name="Tgl">1 </option>
  81. <option name="Tgl">2 </option>
  82. <option name="Tgl">3 </option>
  83. <option name="Tgl">4 </option>
  84. <option name="Tgl">5 </option>
  85. <option name="Tgl">6 </option>
  86. <option name="Tgl">7 </option>
  87. <option name="Tgl">8 </option>
  88. <option name="Tgl">9 </option>
  89. <option name="Tgl">10 </option>
  90. <option name="Tgl">11 </option>
  91. <option name="Tgl">12 </option>
  92. <option name="Tgl">13 </option>
  93. <option name="Tgl">14 </option>
  94. <option name="Tgl">15 </option>
  95. <option name="Tgl">16 </option>
  96. <option name="Tgl">17 </option>
  97. <option name="Tgl">18 </option>
  98. <option name="Tgl">19 </option>
  99. <option name="Tgl">20 </option>
  100. <option name="Tgl">21 </option>
  101. <option name="Tgl">22 </option>
  102. <option name="Tgl">23 </option>
  103. <option name="Tgl">24 </option>
  104. <option name="Tgl">26 </option>
  105. <option name="Tgl">27 </option>
  106. <option name="Tgl">28 </option>
  107. <option name="Tgl">29 </option>
  108. <option name="Tgl">30 </option>
  109. <option name="Tgl">31 </option>
  110. </select>
  111.  
  112. <select name="Bln">
  113. <option name="Bln">Bln </option
  114. ><option name="Bln">Januari </option
  115. ><option name="Bln">Februari </option
  116. ><option name="Bln">Maret </option
  117. ><option name="Bln">April </option
  118. ><option name="Bln">Mei </option
  119. ><option name="Bln">Juni </option
  120. ><option name="Bln">Juli </option
  121. ><option name="Bln">Agustus </option
  122. ><option name="Bln">September </option
  123. ><option name="Bln">Oktober </option
  124. ><option name="Bln">November </option
  125. ><option name="Bln">Desember </option></select
  126. >
  127.  
  128. <select name="Thn">
  129. <option name="Thn">Thn </option
  130. ><option name="Thn">2019 </option
  131. ><option name="Thn">2018 </option
  132. ><option name="Thn">2017 </option
  133. ><option name="Thn">2016 </option
  134. ><option name="Thn">2015 </option
  135. ><option name="Thn">2014 </option
  136. ><option name="Thn">2013 </option
  137. ><option name="Thn">2012 </option
  138. ><option name="Thn">2011 </option
  139. ><option name="Thn">2010 </option
  140. ><option name="Thn">2009 </option
  141. ><option name="Thn">2008 </option
  142. ><option name="Thn">2007 </option
  143. ><option name="Thn">2006 </option></select>
  144. </select>
  145. </td>
  146. </tr>
  147. <tr>
  148. <td>Asal Sekolah</td>
  149. <td></td>
  150. <td>:</td>
  151. <td><input type="Asalsekolah"></td>
  152. </tr>
  153. <tr>
  154. <td>No Telp/HP</td>
  155. <td></td>
  156. <td>:</td>
  157. <td><input type="Notelpatauhp"></td>
  158. </tr>
  159. <tr>
  160. <td>Tahun Tamat SMA</td>
  161. <td></td>
  162. <td>:</td>
  163. <td>
  164. <input type ="tahuntamat">
  165. <select name="tahuntamat">
  166. <option name="Thn">Thn </option
  167. ><option name="Thn">2019 </option
  168. ><option name="Thn">2018 </option
  169. ><option name="Thn">2017 </option
  170. ><option name="Thn">2016 </option
  171. ><option name="Thn">2015 </option
  172. ><option name="Thn">2014 </option
  173. ><option name="Thn">2013 </option
  174. ><option name="Thn">2012 </option
  175. ><option name="Thn">2011 </option
  176. ><option name="Thn">2010 </option
  177. ><option name="Thn">2009 </option
  178. ><option name="Thn">2008 </option
  179. ><option name="Thn">2007 </option
  180. ><option name="Thn">2006 </option>
  181. </select>
  182. </td>
  183. </tr>
  184. <tr>
  185. <td>Jenis Kelamin</td>
  186. <td></td>
  187. <td>:</td>
  188. <td>
  189. <input type="radio" name="jenis_kelamin" value="pria"> Pria
  190. <input type="radio" name="jenis_kelamin" value="wanita"> Wanita
  191. </td>
  192. </tr>
  193. <tr>
  194. <td>Pilih Jurusan</td>
  195. <td></td>
  196. <td>:</td>
  197. <td>
  198. <br>
  199. <input type="radio" name="pilihjurusan" value="TI">TEKNIK INFORMATIKA
  200. <br>
  201. <input type="radio" name="pilihjurusan" value="MI">MANAJEMEN INFORMATIKA
  202. <br>
  203. <input type="radio" name="pilihjurusan" value="AKUN">AKUNTANSI
  204. <br>
  205. </td>
  206. </tr>
  207. <tr>
  208. <td>Jenjang Study</td>
  209. <td></td>
  210. <td>:</td>
  211. <td>
  212. <input type="radio" name="Jenjangstudy" value="D3">D3
  213. <input type="radio" name="Jenjangstudy" value="D4">D4
  214. </td>
  215. </tr>
  216. </tr>
  217. <form class="button"></form>
  218. <tr>
  219. <td>
  220. <center><input type="submit" value="Send Data"></center>
  221. </td>
  222. <td>
  223. <center><input type="submit" value="Cleardata"></center>
  224. </td>
  225. </tr>
  226. </table>
  227. </form>
  228. </div>
  229. </div>
  230. </body>
  231. </html>
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