<div class="panel">
  <div class="panel-heading" style="background: #275555ff; color: honeydew;">
    <h2 align="center" style="margin-top: 10px;">FORM ISIAN<br><b>IDENTITAS DIRI CALON MAHASISWA</b> </h2>
    <!-- <hr> -->
  </div>
  <div class="panel-body">

    <div class="form-group" style="padding-bottom:30px;">
      <label class="col-sm-3 control-label" style="text-align:right; margin-top:6px">Nomor Pendaftaran <span class="text-danger">*</span></label>
      <div class="col-sm-9 prepend-icon" style="margin-top:1px;">
        <input type="text" name="nis" class="form-control bg-blue class" onkeypress="return hanyaAngka(this);" maxlength="30" placeholder="Nomor Induk Siswa" data-parsley-group="block1" data-parsley-errors-container='div[id="error-nis"]' value="<?= $id_daftar; ?>" readonly required>
        <i class="fa fa-users" style="margin-left:15px;"></i>
        <div id="error-nis" style=" background:#FFBABA; color: #D8000C; width:auto; padding-left:10px; font-size: 10px;"></div>
        <div id="pesan_komentar">*Jangan mengganti isian ini.</div>
      </div>
    </div>

    <div class="form-group" style="padding-bottom:30px;">
      <label class="col-sm-3 control-label" style="text-align:right; margin-top:6px">Nama Lengkap <span class="text-danger">*</span></label>
      <div class="col-sm-9 prepend-icon">
        <input type="text" name="nama_lengkap" class="form-control bg-blue" placeholder="Nama lengkap Calon Siswa" maxlength="100" data-parsley-group="block1" data-radio="iradio_square-blue" data-parsley-errors-container='div[id="error-nama_lengkap"]' required>
        <i class="fa fa-user" style="margin-left:15px;"></i>
        <div id="error-nama_lengkap" style=" background:#FFBABA; color: #D8000C; width:auto; padding-left:10px; font-size: 10px;"></div>
        <div id="pesan_komentar">*Sesuai dengan akte kelahiran/ijazah</div>
      </div>
    </div>

    <div class="form-group" style="padding-bottom:30px;">
      <label class="col-sm-3 control-label" style="text-align:right; margin-top:6px">N.I.S.N <span class="text-danger">*</span></label>
      <div class="col-sm-9 prepend-icon" style="margin-top:1px;">
        <input type="text" name="nisn" class="form-control bg-blue class" onkeypress="return hanyaAngka(this);" maxlength="10" placeholder="Nomor Induk Siswa Nasional" data-parsley-group="block1" data-parsley-errors-container='div[id="error-nisn"]'>
        <i class="fa fa-users" style="margin-left:15px;"></i>
        <div id="error-nisn" style=" background:#FFBABA; color: #D8000C; width:auto; padding-left:10px; font-size: 10px;"></div>
        <div id="pesan_komentar">*Sesuai dengan data dari web http://nisn.data.kemdikbud.go.id/kartu NISN</div>
      </div>
    </div>

    <div class="form-group" style="padding-bottom:30px;">
      <label class="col-sm-3 control-label" style="text-align:right; margin-top:6px">NIK Calon Mahasiswa <span class="text-danger">*</span></label>
      <div class="col-sm-9 prepend-icon">
        <input type="text" name="nik" class="form-control bg-blue" placeholder="NIK Siswa" maxlength="100" data-parsley-group="block1" data-radio="iradio_square-blue" data-parsley-errors-container='div[id="error-nik"]' required>
        <i class="fa fa-user" style="margin-left:15px;"></i>
        <div id="error-nik" style=" background:#FFBABA; color: #D8000C; width:auto; padding-left:10px; font-size: 10px;"></div>
        <div id="pesan_komentar">*Sesuai dengan akte kelahiran/ijazah</div>
      </div>
    </div>

    <div class="form-group">
      <label class="col-sm-3 control-label" style="text-align:right; margin-top:6px">Jurusan <span class="text-danger">*</span></label>
      <div class="col-sm-9" style="margin-top:3px;">
        <select class="form-control bg-blue class" data-placeholder="Pilih Jurusan yang Diinginkan" name="komp_ahli" data-parsley-group="block1" data-parsley-errors-container='div[id="error-komp-ahli"]' required>
          <option value="">Pilih salah satu</option>
          <?php foreach ($v_komp as $baris) : ?>
            <option value="<?php echo $baris->kompetensi; ?>"><?php echo $baris->kompetensi; ?></option>
          <?php endforeach; ?>
        </select>
        <div id="pesan_komentar">*Pilih jurusan yang diinginkan</div>
        <div id="error-komp-ahli" style=" background:#FFBABA; color: #D8000C; width:auto; padding-left:10px; font-size: 10px;"></div>
      </div>
    </div>

    <div class="form-group">
      <label class="col-sm-3 control-label" style="text-align:right; margin-top:-3px">Jenis Kelamin <span class="text-danger">*</span></label>
      <div class="col-sm-9">
        <div class="radio" style="margin-top:3px;margin-left:-20px;">
          <label>
            <input type="radio" value="Laki-Laki" name="jk" data-parsley-group="block1" data-radio="iradio_square-blue" data-parsley-errors-container='div[id="condition-error"]' required> <i class="fa fa-male"></i> &nbsp;Laki-laki
          </label>
        </div>
        <div class="radio" style="margin-left:-20px;">
          <label>
            <input type="radio" value="Perempuan" name="jk" data-parsley-group="block1" data-radio="iradio_square-blue" data-parsley-errors-container='div[id="condition-error"]' required> <i class="fa fa-female"></i> &nbsp;Perempuan
          </label>
        </div>
        <div id="condition-error" style=" background:#FFBABA; color: #D8000C; width:auto; padding-left:10px; font-size: 10px;"></div>
      </div>
    </div>

    <div class="form-group">
      <label class="col-sm-3 control-label" style="text-align:right; margin-top:6px">Tempat Kelahiran <span class="text-danger">*</span></label>
      <div class="col-sm-9 prepend-icon">
        <input type="text" name="tempat_lahir" class="form-control bg-blue class" placeholder="Tempat Kelahiran Calon Siswa" data-parsley-group="block1" data-parsley-errors-container='div[id="error-tempat_lahir"]' required>
        <i class="fa fa-building" style="margin-left:15px;"></i>
        <div id="error-tempat_lahir" style=" background:#FFBABA; color: #D8000C; width:auto; padding-left:10px; font-size: 10px;"></div>
      </div>
    </div>

    <div class="form-group">
      <label class="col-sm-3 control-label" style="text-align:right; margin-top:6px">Tanggal Kelahiran <span class="text-danger">*</span></label>
      <div class="col-sm-9" style="margin-top:3px;">
        <div class="col-sm-4" style="padding:0px">
          <select class="form-control bg-blue class" name="tgl_lahir" data-parsley-group="block1" data-parsley-errors-container='div[id="error-tgl_lahir"]' required>
            <option value="" selected>Pilih Tanggal</option>
            <?php for ($i = 1; $i <= 31; $i++) {
              if ($i < 10) {
                $i = "0" . $i;
              } ?>
              <option value="<?php echo $i; ?>"><?php echo $i; ?></option>
            <?php } ?>
          </select>
          <div id="error-tgl_lahir" style=" background:#FFBABA; color: #D8000C; width:auto; padding-left:10px; font-size: 10px;"></div>
        </div>

        <div class="col-sm-4" style="padding-left:3px;">
          <select class="form-control bg-blue class" data-placeholder="Pilih Bulan" name="bln_lahir" data-parsley-group="block1" data-parsley-errors-container='div[id="error-bln_lahir"]' required>
            <option value="" selected>Pilih Bulan</option>
            <option value="01">Januari</option>
            <option value="02">Februari</option>
            <option value="03">Maret</option>
            <option value="04">April</option>
            <option value="05">Mei</option>
            <option value="06">Juni</option>
            <option value="07">Juli</option>
            <option value="08">Agustus</option>
            <option value="09">September</option>
            <option value="10">Oktober</option>
            <option value="11">November</option>
            <option value="12">Desember</option>
          </select>
          <div id="error-bln_lahir" style=" background:#FFBABA; color: #D8000C; width:auto; padding-left:10px; font-size: 10px;"></div>
        </div>

        <div class="col-sm-4" style="margin-left:-27px;">
          <select class="form-control bg-blue class" data-placeholder="Pilih Tahun Lahir" name="thn_lahir" data-parsley-group="block1" data-parsley-errors-container='div[id="error-thn_lahir"]' required>
            <option value="" selected>Pilih Tahun Lahir</option>
            <?php
            $thn_max = date('Y') - 2;
            for ($i = 1990; $i <= $thn_max; $i++) { ?>
              <option value="<?php echo $i; ?>"><?php echo $i; ?></option>
            <?php } ?>
          </select>
          <div id="error-thn_lahir" style=" background:#FFBABA; color: #D8000C; width:auto; padding-left:10px; font-size: 10px;"></div>
        </div>
      </div>
    </div>

    <div class="form-group">
      <label class="col-sm-3 control-label" style="text-align:right; margin-top:6px">Agama <span class="text-danger">*</span></label>
      <div class="col-sm-9" style="margin-top:3px;">
        <select class="form-control bg-blue class" data-placeholder="Pilih Agama yang dianut" name="agama" data-parsley-group="block1" data-parsley-errors-container='div[id="error-agama"]' required>
          <option value="">Pilih agama yang dianut</option>
          <option value="Islam">Islam</option>
          <option value="Kristen">Kristen</option>
          <option value="Katolik">Katolik</option>
          <option value="Hindu">Hindu</option>
          <option value="Budha">Budha</option>
          <option value="Konghucu">Konghucu</option>
          <option value="lainnya">Lainnya</option>
        </select>
        <div id="error-agama" style=" background:#FFBABA; color: #D8000C; width:auto; padding-left:10px; font-size: 10px;"></div>
      </div>
    </div>

    <div class="form-group">
      <label class="col-sm-3 control-label" style="text-align:right; margin-top:6px">Status dlm Keluarga <span class="text-danger">*</span></label>
      <div class="col-sm-9" style="margin-top:3px;">
        <select class="form-control bg-blue class" data-placeholder="Pilih Status dalam Keluarga" name="status_keluarga" data-parsley-group="block1" data-parsley-errors-container='div[id="error-status_keluarga"]' required>
          <option value="">Pilih Status dalam Keluarga</option>
          <option value="Anak Kandung">Anak Kandung</option>
          <option value="Anak Angkat">Anak Angkat</option>
        </select>
        <div id="error-status_keluarga" style=" background:#FFBABA; color: #D8000C; width:auto; padding-left:10px; font-size: 10px;"></div>
      </div>
    </div>

    <div class="form-group" style="padding-bottom:30px;">
      <label class="col-sm-3 control-label" style="text-align:right; margin-top:6px">Anak Ke <span class="text-danger">*</span></label>
      <div class="col-sm-9 prepend-icon">
        <input type="text" name="anak_ke" class="form-control bg-blue" placeholder="Anak Ke-" maxlength="100" data-parsley-group="block1" data-radio="iradio_square-blue" data-parsley-errors-container='div[id="error-anak_ke"]' required>
        <i class="fa fa-user" style="margin-left:15px;"></i>
        <div id="error-anak_ke" style=" background:#FFBABA; color: #D8000C; width:auto; padding-left:10px; font-size: 10px;"></div>
        <div id="pesan_komentar">*Isi dengan angka</div>
      </div>
    </div>

    <div class="form-group" style="padding-bottom:30px;">
      <label class="col-sm-3 control-label" style="text-align:right; margin-top:6px">Jumlah Saudara <span class="text-danger">*</span></label>
      <div class="col-sm-9 prepend-icon">
        <input type="text" name="jml_saudara" class="form-control bg-blue" placeholder="Jumlah Saudara Kandung" maxlength="100" data-parsley-group="block1" data-radio="iradio_square-blue" data-parsley-errors-container='div[id="error-jml_saudara"]' required>
        <i class="fa fa-user" style="margin-left:15px;"></i>
        <div id="error-jml_saudara" style=" background:#FFBABA; color: #D8000C; width:auto; padding-left:10px; font-size: 10px;"></div>
        <div id="pesan_komentar">*Isi dengan angka</div>
      </div>
    </div>

    <div class="form-group">
      <label class="col-sm-3 control-label" style="text-align:right; margin-top:6px">Hobi <span class="text-danger">*</span></label>
      <div class="col-sm-9" style="margin-top:3px;">
        <select class="form-control bg-blue class" data-placeholder="Pilih Hobi Siswa" name="hobi" data-parsley-group="block1" data-parsley-errors-container='div[id="error-hobi"]' required>
          <option value="">Pilih minat hobi</option>
          <option value="1">Olah raga</option>
          <option value="2">Kesenian</option>
          <option value="3">Membaca</option>
          <option value="4">Menulis</option>
          <option value="5">Travelling</option>
          <option value="6">Lainnya</option>
        </select>
        <div id="error-hobi" style=" background:#FFBABA; color: #D8000C; width:auto; padding-left:10px; font-size: 10px;"></div>
      </div>
    </div>

    <div class="form-group">
      <label class="col-sm-3 control-label" style="text-align:right; margin-top:6px">Cita-cita <span class="text-danger">*</span></label>
      <div class="col-sm-9" style="margin-top:3px;">
        <select class="form-control bg-blue class" data-placeholder="Pilih Cita-cita Siswa" name="cita" data-parsley-group="block1" data-parsley-errors-container='div[id="error-cita"]' required>
          <option value="">Pilih cita-cita calon mahasiswa</option>
          <option value="1">PNS</option>
          <option value="2">TNI/Polri</option>
          <option value="3">Guru/Dosen</option>
          <option value="4">Dokter</option>
          <option value="5">Politikus</option>
          <option value="6">Wiraswasta</option>
          <option value="7">Pekerja Seni/lukis/artis/sejenis</option>
          <option value="8">Lainnya</option>
        </select>
        <div id="error-cita" style=" background:#FFBABA; color: #D8000C; width:auto; padding-left:10px; font-size: 10px;"></div>
      </div>
    </div>

    <div class="form-group">
      <label class="col-sm-3 control-label" style="text-align:right; margin-top:6px">PAUD <span class="text-danger">*</span></label>
      <div class="col-sm-9" style="margin-top:3px;">
        <select class="form-control bg-blue class" data-placeholder="Pernah PAUD?" name="paud" data-parsley-group="block1" data-parsley-errors-container='div[id="error-paud"]' required>
          <option value="">Apakah pernah PAUD?</option>
          <option value="1">Pernah</option>
          <option value="2">Tidak Pernah</option>
        </select>
        <div id="error-paud" style=" background:#FFBABA; color: #D8000C; width:auto; padding-left:10px; font-size: 10px;"></div>
      </div>
    </div>

    <div class="form-group">
      <label class="col-sm-3 control-label" style="text-align:right; margin-top:6px">TK <span class="text-danger">*</span></label>
      <div class="col-sm-9" style="margin-top:3px;">
        <select class="form-control bg-blue class" data-placeholder="Pernah PAUD?" name="tk" data-parsley-group="block1" data-parsley-errors-container='div[id="error-tk"]' required>
          <option value="">Apakah pernah TK?</option>
          <option value="1">Pernah</option>
          <option value="2">Tidak Pernah</option>
        </select>
        <div id="error-tk" style=" background:#FFBABA; color: #D8000C; width:auto; padding-left:10px; font-size: 10px;"></div>
      </div>
    </div>



    <div class="form-group">
      <label class="col-sm-3 control-label" style="text-align:right; margin-top:6px">No. Handphone/WA <span class="text-danger">*</span></label>
      <div class="col-sm-9 prepend-icon" style="margin-top:3px;">
        <input type="text" name="no_hp_siswa" class="form-control bg-blue class" maxlength="14" onkeypress="return hanyaAngka(this);" placeholder="No. Handphone Calon Siswa" data-parsley-group="block1" data-parsley-errors-container='div[id="error-no_hp_siswa"]' required>
        <i class="fa fa-phone" style="margin-left:15px;"></i>
        <div id="error-no_hp_siswa" style=" background:#FFBABA; color: #D8000C; width:auto; padding-left:10px; font-size: 10px;"></div>
      </div>
    </div>

  </div>
</div>

<div class="col-md-12">
  <div>