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<title>tugas desainweb 3</title>
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<center>
<div class="head">Nur Cholis : 3095111275</div>
<div id="wrapper">
<span class="home">Home</span>
<span class="login">Pilihan Jurusan</span>
<span class="daftar">Data Diri</span>
<span class="about">Data Orang Tua</span>
<span class="contact">Data Sekolah</span>
<div id="home">
<div id="wraper">
<div style="color:#000;background-image:url(images/uty.jpg); height:450px; font-weight:bold; border-radius:230px;">
<h1>Formulir Pendaftaran Mahasiswa</h1><br/><br/><br/>
<h2>Fakultas Bisnis Dan Teknologi Informasi</h2>
<h2>Fakultas Sains dan Teknologi</h2>
<H2>Fakultas Sastra dan Bahasa</H2>
<h2>Fakultas Psikologi</h2><br/><br/><br/>
<h1>UNIVERSITAS TEKNOLOGI YOGYAKARTA</h1>
<h2>2013</h2>
</div>
</div>
</div>
<div id="loginform" >
<div id="wraper">
<form>
<fieldset>
<legend>Pilihan Jurusan</legend>
<label for="pilJur">Pilih Jurusan 1</label>
<div style="width:100px; height:135px; border:solid 1px #FFFFFF;float:right;"> </div>
<select name="pilJur" required>
<option selected="" required>Pilih Jurusan 1</option>
<option value="S2MM" required>S2 Magister Manajemen</option>
<option value="S1Ti" required>S1 Teknik Informatika</option>
<option value="S1Si" required>S1 Sistem Informasi</option>
<option value="S1A" required>S1 Akuntansi</option>
<option value="S1M" required>S1 Manajemen</option>
<option value="D3M" required>D3 Akuntansi</option>
<option value="D3Mi" required>D3 Manajemen Informatika</option>
<option value="S1Ts" required>S1 Teknik Sipil</option>
<option value="S1TE" required>S1 Teknik Elektro</option>
<option value="S1Tin" required>S1 Teknik Industri</option>
<option value="S1Ar" required>S1 Arsitek</option>
<option value="S1Sk" required>S1 Sistem Komputer</option>
<option value="S1Sing" required>S1 Sastra Inggris</option>
<option value="S1Sj" required>S1 Sastra Jepang</option>
</select><br/><br/>
<label for="namalengkap" required>Pilih Jurusan 2 </label><br/>
<select name="pilJur" required>
<option selected="" required>Pilih Jurusan 2</option>
<option value="S2MM" required>S2 Magister Manajemen</option>
<option value="S1Ti" required>S1 Teknik Informatika</option>
<option value="S1Si" required>S1 Sistem Informasi</option>
<option value="S1A" required>S1 Akuntansi</option>
<option value="S1M" required>S1 Manajemen</option>
<option value="D3M" required>D3 Akuntansi</option>
<option value="D3Mi" required>D3 Manajemen Informatika</option>
<option value="S1Ts" required>S1 Teknik Sipil</option>
<option value="S1TE" required>S1 Teknik Elektro</option>
<option value="S1Tin" required>S1 Teknik Industri</option>
<option value="S1Ar" required>S1 Arsitek</option>
<option value="S1Sk" required>S1 Sistem Komputer</option>
<option value="S1Sing" required>S1 Sastra Inggris</option>
<option value="S1Sj" required>S1 Sastra Jepang</option>
</select><br/><br/><br/><br/>
<label for="foto" style="float:right;" >Masukkan Foto <sup>*</sup></label><br/><br/>
<input type="file" name="foto" required placeholder="Masukkan Foto" style="float:right;"><br/><br/><br/>
<a href="daftar"> <input type="button" class="button" name="submit" value="Submit"/></a>
<input type="reset" class="button" name="reset" value="Reset"/>
<br/><br/><p class="small"><sup>*</sup> Wajib diisi.</p>
<p class="small">Setelah mengisi data jurusan kemudian isi data diri anda.</p>
</fieldset>
</form>
</div>
</div>
<div id="daftar">
<div id="wraper" align="center">
<div align="left">
<form>
<fieldset>
<legend>Data Diri</legend>
<label for="namalengkap">Nama Lengkap <sup>*</sup></label><br/>
<input class="data" name="namalengkap" placeholder="Nama Lengkap" size="30" required /><br/>
<label for="alamat" >Tempat Lahir <sup>*</sup></label><br/>
<input class="data" name="tpt_lhr" placeholder="Tempat Lahir" size="50" required /><br/>
<label for="tglahir">Tanggal Lahir<sup>*</sup></label><br/>
<input class="data" name="tglahir" type="date" placeholder="25/12/2012" required/><br/>
<label for="alamatemail" >Alamat Email <sup>*</sup></label><br/>
<input class="data" type="email" name="alamatemail" placeholder="nurcholis2310@yahoo.com" size="40" required /><br/><br/>
<label for="alamat" >Jenis Kelamin </label><br/>
<input type="radio" name="sex" id="lk" value="lk" required />
<label for="male">Laki - Laki</label>
<input type="radio" name="sex" id="pr" value="pr" required />
<label for="female">Perempuan</label><br/><br/>
<label for="alamat" >Alamat <sup>*</sup></label><br/>
<input class="data" name="alamat" placeholder="Alamat" size="50" required /><br/>
<label for="kota" >Kota <sup></sup></label><br/>
<input class="data" name="kt" placeholder="Kota" size="40" required /><br/><br/>
<label for="namalengkap" required>Provinsi </label><br/>
<select class="data" name="pilJur" required>
<option selected="" required>Pilih Provinsi</option>
<option value="Aceh" required>Aceh</option>
<option value="Bali" required>Bali</option>
<option value="Banten" required>Banten</option>
<option value="Bengkulu" required>Bengkulu</option>
<option value="Gorontalo" required>Gorontalo</option>
<option value="Jakarta" required>Jakarta</option>
<option value="Jambi" required>Jambi</option>
<option value="Jawa Barat" required>Jawa Barat</option>
<option value="Jawa Tengah" required>Jawa Tengah</option>
<option value="Jawa Timur" required>Jawa Timur</option>
<option value="Kalimantan Barat" required>Kalimantan Barat</option>
<option value="Kalimantan Selatan" required>Kalimantan Selatan</option>
<option value="Kalimantan Tengah" required>Kalimantan Tengah</option>
<option value="Kalimantan Timur" required>Kalimantan Timur</option>
<option value="Kalimantan Utara" required>Kalimantan Utara</option>
<option value="Kepulauan Bangka Belitung" required>Kepulauan Bangka Belitung</option>
<option value="Kepulauan Riau" required>Kepulauan Riau</option>
<option value="Lampung" required>Lampung</option>
<option value="Maluku" required>Maluku</option>
<option value="Maluku Utara" required>Maluku Utara</option>
<option value="Nusa Tenggara Barat" required>Nusa Tenggara Barat</option>
<option value="Nusa Tenggara Timur" required>Nusa Tenggara Timur </option>
<option value="Papua" required>Papua</option>
<option value="Papua Barat" required>Papua Barat</option>
<option value="Riau" required>Riau</option>
<option value="Sulawesi Barat" required>Sulawesi Barat</option>
<option value="Sulawesi Selatan" required>Sulawesi Selatan</option>
<option value="Sulawesi Tengah" required>Sulawesi Tengah</option>
<option value="Sulawesi Tenggara" required>Sulawesi Tenggara</option>
<option value="Sulawesi Utara" required>Sulawesi Utara</option>
<option value="Sumatera Barat" required>Sumatera Barat</option>
<option value="Sumatera Selatan" required>Sumatera Selatan</option>
<option value="Sumatera Utara" required>Sumatera Utara</option>
<option value="Yogyakarta" required>Yogyakarta</option>
</select><br/><br/>
<label for="no_hp" >Nomer Hp / Tlp <sup>*</sup></label><br/>
<input class="data" name="no_hp" placeholder="Nomor HP" required /><br/><br/>
<label for="golDrh" required>Golongan Darah </label><br/>
<select name="pilJur" required>
<option selected="" required>Golngan Darah</option>
<option value="S1" required>A</option>
<option value="S1" required>B</option>
<option value="D1" required>AB</option>
<option value="D1" required>O</option>
</select><br/><br/>
<label for="namalengkap" required>Pilih Agama </label><br/>
<select class="data" name="pilJur" required>
<option selected="" required>Piih Agama</option>
<option value="S1" required>Islam</option>
<option value="S1" required>Kristen</option>
<option value="D1" required>Katolik</option>
<option value="D1" required>Hindu</option>
<option value="D1" required>Budha</option>
<option value="D1" required>Other</option>
</select><br/><br/><br/><br/>
<input type="submit" class="button" name="submit" value="Submit"/>
<input type="reset" class="button" name="reset" value="Reset"/>
<br/><br/><p class="small"><sup>*</sup> Wajib diisi.</p>
<p class="small">Setelah mengisi data diri kemudian isi data orang tua anda.</p>
</fieldset>
</form>
</div>
</div>
</div>
<div id="about">
<div id="wraper">
<div align="left">
<form>
<fieldset>
<legend>Data Orang Tua / Wali</legend>
<label for="namalengkap">Nama Orang Tua / Wali <sup>*</sup></label><br/>
<input class="data" name="namalengkap" placeholder="Nama Lengkap" required /><br/>
<label for="tptLhr" >Tempat Lahir <sup>*</sup></label><br/>
<input class="data" name="tpt_lhr" placeholder="tpt_lhr" required /><br/>
<label for="tglahir">Tanggal Lahir<sup>*</sup></label><br/>
<input class="data" name="tglahir" type="date" style="width:200px" required/><br/>
<label for="pilpek" required>Pilih Pekerjaan </label><br/>
<select name="pilpek" required>
<option selected="" required>Piih Pekerjaan</option>
<option value="S1" required>PNS</option>
<option value="S1" required>TNI</option>
<option value="D1" required>Polri</option>
<option value="D1" required>Wiraswasta</option>
<option value="D1" required>Wirausaha</option>
<option value="D1" required>Other</option>
</select><br/> <br/>
<label for="peklain" >Pekerjaan Lain <sup>*</sup></label><br/>
<input class="data" type="text" name="peklain" placeholder="Pekerjaan Lain" style="width:200px" required /><br/>
<label for="alamat" >Alamat <sup>*</sup></label><br/>
<input class="data" name="alamat" placeholder="Alamat" required /><br/>
<label for="kota" >Kota <sup></sup></label><br/>
<input class="data" name="kt" placeholder="Kota" /><br/>
<label for="prov" required>Provinsi</label><br/>
<select name="prov" required>
<option selected="" required>Pilih Provinsi</option>
<option value="S1" required>Aceh</option>
<option value="S1" required>Bali</option>
<option value="D1" required>Banten</option>
<option value="D1" required>Bengkulu</option>
<option value="S1" required>Gorontalo</option>
<option value="S1" required>Jakarta</option>
<option value="D1" required>Jambi</option>
<option value="D1" required>Jawa Barat</option>
<option value="S1" required>Jawa Tengah</option>
<option value="D1" required>Jawa Timur</option>
<option value="D1" required>Kalimantan Barat</option>
<option value="S1" required>Kalimantan Selatan</option>
<option value="D1" required>Kalimantan Tengah</option>
<option value="D1" required>Kalimantan Timur</option>
<option value="S1" required>Kalimantan Utara</option>
<option value="S1" required>Kepulauan Bangka Belitung</option>
<option value="D1" required>Kepulauan Riau</option>
<option value="D1" required>Lampung</option>
<option value="S1" required>Maluku</option>
<option value="S1" required>Maluku Utara</option>
<option value="D1" required>Nusa Tenggara Barat</option>
<option value="D1" required>Nusa Tenggara Timur </option>
<option value="S1" required>Papua</option>
<option value="D1" required>Papua Barat</option>
<option value="D1" required>Riau</option>
<option value="S1" required>Sulawesi Barat</option>
<option value="D1" required>Sulawesi Selatan</option>
<option value="D1" required>Sulawesi Tengah</option>
<option value="S1" required>Sulawesi Tenggara</option>
<option value="S1" required>Sulawesi Utara</option>
<option value="D1" required>Sumatera Barat</option>
<option value="D1" required>Sumatera Selatan</option>
<option value="S1" required>Sumatera Utara</option>
<option value="S1" required>Yogyakarta</option>
</select><br/><br/>
<label for="no_hp" >Nomer Hp / Tlp <sup>*</sup></label><br/>
<input class="data" name="no_hp" placeholder="62857xxxxxxxx" required /><br/><br/><br/>
<input type="submit" class="button" name="submit" value="Submit"/>
<input type="reset" class="button" name="reset" value="Reset"/>
<br/><br/><p class="small"><sup>*</sup> Wajib diisi.</p>
<p class="small">Setelah mengisi data Orang tua kemudian isi data sekolah asal anda.</p>
</fieldset>
</form>
</div>
</div>
</div>
<div id="contact">
<div id="wraper">
<div align="left">
<form>
<fieldset>
<legend>Data Sekolah</legend>
<label for="namaSek">Nama Sekolah Asal <sup>*</sup></label><br/>
<input class="data" name="namaSek" placeholder="Nama Sekolah" required /><br/>
<label for="jenSek" required>Jenis Sekolah</label><br/>
<select name="jenSek" required>
<option selected="selected" required>Jenis Sekolah</option>
<option value="S1" required>SMK</option>
<option value="S1" required>SMA</option>
<option value="D1" required>MA</option>
<option value="D1" required>Other</option>
</select><br/> <br/>
<label for="thnLls" >Tahun Lulus</label><br/>
<select name="thnLls">
<option selected="selected">Tahun</option><br/>
<?php
for($i=2012; $i>=2000; $i-=1){
echo"<option value=$bulan[$c]> $i </option>";
}
?>
</select><br/><br/>
<label for="info" required>Mendapatkan Info Dari :</label><br/>
<select name="info" required>
<option selected="selected" required>Pilih Informasi</option>
<option value="S1" required>Kunjungan Universitas</option>
<option value="D1" required>Informasi Dari Teman / Saudara</option>
<option value="S1" required>Internet</option>
<option value="D1" required>Brosur</option>
<option value="S1" required>Koran</option>
<option value="D1" required>Other</option>
</select><br/><br/><br/>
<input type="submit" class="button" name="submit" value="Submit"/>
<input type="reset" class="button" name="reset" value="Reset"/>
<br/><br/><p class="small"><sup>*</sup> Wajib diisi.</p>
</fieldset>
</form>
</div>
</div>
</div>
</center>
</body>
</html>
Code lengkap silahkan download disini...
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