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formulir.php
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formulir.php
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<?php
include "header.php";
include "conf/koneksi.php";
include "lib/inc.session.php";
include "format_tanggal.php";
$sql = mysqli_query($connect, "select * from pengguna where nik = '$_SESSION[nik]' and hak_akses = 'Siswa'");
$r = mysqli_fetch_array($sql);
$query = mysqli_query($connect, "SELECT * FROM pendaftar_siswa WHERE pendaftar_siswa.nik = '$_SESSION[nik]'");
$cek = mysqli_num_rows($query);
$p = mysqli_fetch_array($query);
$sql = mysqli_query($connect, "SELECT * FROM pendaftaran WHERE aktif = 'Ya'");
$s = mysqli_fetch_array($sql);
$tgl = date('YMD');
$wkt = $s['tgl_selesai'];
?>
<script type="text/javascript" src="js/jquery-2.2.3.min.js"></script>
<script type="text/javascript">
$(document).ready(function() {
if ($("#status_sekolah").val() == "Pindahan") {
$('#nama_sekolah').removeAttr('readonly');
$('#nis_lama').removeAttr('readonly');
$('#alamat_sekolah').removeAttr('readonly');
$('#tgl_pindah').removeAttr('readonly');
$('#tingkat_kelas').removeAttr('readonly');
$('#alasan_pindah').removeAttr('readonly');
}else{
$('#nama_sekolah').attr('readonly','readonly');
$('#nis_lama').attr('readonly','readonly');
$('#alamat_sekolah').attr('readonly','readonly');
$('#tgl_pindah').attr('readonly','readonly');
$('#tingkat_kelas').attr('readonly','readonly');
$('#alasan_pindah').attr('readonly','readonly');
}
$("#status_sekolah").change(function() {
if (this.value == "Kelas 1 Baru") {
$('#nama_sekolah').attr('readonly','readonly');
$('#nis_lama').attr('readonly','readonly');
$('#alamat_sekolah').attr('readonly','readonly');
$('#tgl_pindah').attr('readonly','readonly');
$('#tingkat_kelas').attr('readonly','readonly');
$('#alasan_pindah').attr('readonly','readonly');
$('#alamat_sekolah').val('-');
$('#tgl_pindah').val('-');
$('#nama_sekolah').val('-');
$('#nis_lama').val('-');
$('#tingkat_kelas').val('-');
$('#alasan_pindah').val('-');
}else{
$('#nama_sekolah').removeAttr('readonly');
$('#nis_lama').removeAttr('readonly');
$('#alamat_sekolah').removeAttr('readonly');
$('#tgl_pindah').removeAttr('readonly');
$('#tingkat_kelas').removeAttr('readonly');
$('#alasan_pindah').removeAttr('readonly');
$('#nama_sekolah').focus();
$('#nis_lama').focus();
$('#alamat_sekolah').focus();
$('#tgl_pindah').focus();
$('#tingkat_kelas').focus();
$('#alasan_pindah').focus();
}
});
});
</script>
<div class="header inner_banner" id="home">
<div class="top-bar">
<div class="header-nav-agileits">
<nav class="navbar navbar-default">
<div class="navbar-header">
<button type="button" class="navbar-toggle collapsed" data-toggle="collapse" data-target="#bs-example-navbar-collapse-1">
<span class="sr-only">Toggle navigation</span>
<span class="icon-bar"></span>
<span class="icon-bar"></span>
<span class="icon-bar"></span>
</button>
<h1><a class="navbar-brand" href="index.php"><img src="images/logo-panjang.png" width="300"></a></h1>
</div>
<div class="collapse navbar-collapse nav-wil" id="bs-example-navbar-collapse-1">
<nav>
<ul class="top_nav">
<li><a href="dashboard-siswa" class="active">Dasbor Siswa</a></li>
<li><a href="logout.php">Keluar</a></li>
</ul>
</nav>
</div>
</nav>
</div>
</div>
</div>
<div class="services-breadcrumb-w3ls-agile">
<div class="inner_breadcrumb">
<ul class="short">
<li><a href="dashboard-siswa">Dasbor Siswa</a><span>|</span></li>
<li>Formulir Pendaftaran</li>
</ul>
</div>
</div>
<?php
$carikode = mysqli_query($connect, "SELECT no_daftar from pendaftar_siswa") or die (mysqli_error());
$datakode = mysqli_fetch_array($carikode);
$jumlah_data = mysqli_num_rows($carikode);
if ($datakode) {
$nilaikode = substr($jumlah_data[0], 1);
$kode = (int) $nilaikode;
$kode = $jumlah_data + 1;
$kode_otomatis = "PSA".date('dmY').str_pad($kode, 3, "0", STR_PAD_LEFT);
}else{
$kode_otomatis = "PSA".date('dmY')."001";
}
?>
<div class="banner_bottom">
<div class="container">
<div class="col-md-10 col-md-offset-1">
<h3 class="text-center">Formulir Pendaftaran Siswa Baru:</h3><br>
<div class="alert alert-info">
<strong>A. DATA SISWA / SISWI</strong>
</div>
<form enctype="multipart/form-data" class="contact-form" action="simpan-siswa.php" method="post">
<div class="row">
<div class="col-md-3">
<label>Nomor Pendaftaran:</label>
<input type="hidden" class="form-control" name="id_daftar" value="<?= $s['id_pendaftaran'] ?>" readonly>
<input type="text" class="form-control" name="nodaftar" value="<?= $kode_otomatis ?>" readonly>
</div>
<div class="col-md-3">
<label>NIS:</label>
<input type="text" class="form-control" name="nik" value="<?= $r['nik']; ?>" readonly>
</div>
<div class="col-md-6">
<label>Nama Lengkap:</label>
<input type="text" class="form-control" name="nama" value="<?= $p['nama']; ?>" required>
</div>
</div><br>
<div class="row">
<div class="col-md-3">
<label>Nama Panggilan:</label>
<input type="text" class="form-control" name="nama2" required>
</div>
<div class="col-md-3">
<label>Jenis Kelamin:</label> <br>
<div class="col-sm-6">
<label class="radio">
<input type="radio" name="jk" data-toggle="radio" value="Laki - laki" checked>
Laki-laki
</label>
</div>
<div class="col-sm-2">
<label class="radio">
<input type="radio" name="jk" data-toggle="radio" value="Perempuan">
Perempuan
</label>
</div>
</div>
<div class="col-md-6">
<label>Alamat:</label>
<textarea class="form-control" placeholder="Masukkan Alamat Rumah Anda" rows="4" name="alamat" required></textarea>
</div>
</div><br>
<div class="row">
<div class="col-md-5">
<label>Tempat Lahir:</label>
<input type="text" class="form-control" name="tempat_lahir" placeholder="Masukan Tempat Lahir" required>
</div>
<div class="col-md-3">
<label>Tanggal Lahir:</label>
<input class="datepicker form-control" type="date" name="tgl_lahir" required/>
<input name="tgl_daftar" type="hidden" value="<?= date('mdY') ?>" required/>
</div>
<div class="col-md-4">
<label>No. Akte Lahir:</label>
<input type="text" class="form-control" name="akte_lahir" placeholder="Masukan Nomor Akte Lahir" required>
</div>
</div><br>
<div class="row">
<div class="col-md-2">
<label>Tinggi Badan:</label>
<input class="form-control" type="text" name="tinggi" placeholder="Tinggi badan" required/>
</div>
<div class="col-md-2">
<label>Berat Badan:</label>
<input class="form-control" type="text" name="berat" placeholder="Berat badan" required/>
</div>
<div class="col-md-2">
<label>Anak Ke:</label>
<input class="form-control" type="text" name="anak_ke" placeholder="Anak ke - " required/>
</div>
<div class="col-md-2">
<label>Dari:</label>
<input class="form-control" type="text" name="jml_saudara" placeholder="Total Saudara" required/>
</div>
<div class="col-md-4">
<label>Penyakit Yang Pernah Diderita:</label>
<input class="form-control" type="text" name="penyakit" placeholder="Penyakit yang Pernah Anda Derita" required/>
</div>
</div><br>
<div class="row">
<div class="col-md-3">
<label>Status Sekolah:</label><br>
<select class="form-control" id="status_sekolah" name="status_sekolah" required>
<option value="Kelas 1 Baru">Kelas 1 Baru</option>
<option value="Pindahan">Pindahan</option>
</select>
</div>
<div class="col-md-3">
<label>Nama Sekolah Asal:</label>
<input class="form-control" type="text" name="nama_sekolah" id="nama_sekolah" placeholder="Masukkan Nama Sekolah" value="-"/>
</div>
<div class="col-md-2">
<label>NIS Asal:</label>
<input class="form-control" type="text" name="nis_lama" id="nis_lama" placeholder="Input NIS Asal" value="-"/>
</div>
<div class="col-md-4">
<label>Alamat Sekolah Asal:</label>
<textarea class="form-control" placeholder="Masukkan Alamat Sekolah Asal" rows="4" name="alamat_sekolah" id="alamat_sekolah"><?php echo "-"; ?></textarea>
</div>
</div><br>
<div class="row">
<div class="col-md-3">
<label>Tanggal Surat Pindah:</label>
<input class="form-control" type="text" name="tgl_pindah" id="tgl_pindah" value="-"/>
</div>
<div class="col-md-3">
<label>Tingkat Kelas yang Lama:</label>
<select class="form-control" name="tingkat_kelas" id="tingkat_kelas" value="-">
<option value="-">-</option>
<option value="2">2</option>
<option value="3">2</option>
<option value="4">4</option>
<option value="5">5</option>
<option value="6">6</option>
</select>
</div>
<div class="col-md-6">
<label>Alasan Pindah Sekolah:</label>
<textarea class="form-control" placeholder="Masukkan Alamat Sekolah Asal" rows="4" name="alasan_pindah" id="alasan_pindah"><?php echo "-"; ?></textarea>
</div>
</div><br>
<div class="alert alert-info">
<strong>B. DATA ORANG TUA SISWA / SISWI</strong>
</div>
<div class="row">
<div class="col-md-12">
<label>No. Kartu Keluarga:</label>
<input class="form-control" type="text" name="nomor_kk" placeholder="Masukkan Nomor KK Anda" required/>
</div>
</div><br>
<div class="row">
<div class="col-md-3">
<label>Nama Ayah Kandung:</label>
<input class="form-control" type="text" name="nama_ayah" placeholder="Sebutkan Nama Ayah" required/>
</div>
<div class="col-md-3">
<label>Nomor NIK Ayah:</label>
<input class="form-control" type="text" name="nik_ayah" placeholder="Masukkan Nomor NIK Ayah" required/>
</div>
<div class="col-md-3">
<label>Nama Ibu Kandung:</label>
<input class="form-control" type="text" name="nama_ibu" placeholder="Sebutkan Nama Ibu" required/>
</div>
<div class="col-md-3">
<label>Nomor NIK Ibu:</label>
<input class="form-control" type="text" name="nik_ibu" placeholder="Masukkan Nomor NIK Ibu" required/>
</div>
</div><br>
<div class="row">
<div class="col-md-3">
<label>Pendidikan Ayah:</label>
<select class="form-control" name="pen_ayah" required>
<option value="-">Pilih Pendidikan</option>
<option value="SD">SD</option>
<option value="SLTP">SLTP</option>
<option value="SLTA">SLTA</option>
<option value="D1">D1</option>
<option value="D2">D2</option>
<option value="D3">D3</option>
<option value="D4">D4</option>
<option value="S1">S1</option>
<option value="S2">S2</option>
<option value="S3">S3</option>
<option value="Lain - lain">Lain - lain</option>
</select>
</div>
<div class="col-md-3">
<label>Pekerjaan Ayah:</label>
<input class="form-control" type="text" name="pek_ayah" placeholder="Sebutkan Pekerjaan Ayah" required/>
</div>
<div class="col-md-3">
<label>Pendidikan Ibu:</label>
<select class="form-control" name="pen_ibu" required>
<option value="-">Pilih Pendidikan</option>
<option value="SD">SD</option>
<option value="SLTP">SLTP</option>
<option value="SLTA">SLTA</option>
<option value="D1">D1</option>
<option value="D2">D2</option>
<option value="D3">D3</option>
<option value="D4">D4</option>
<option value="S1">S1</option>
<option value="S2">S2</option>
<option value="S3">S3</option>
<option value="Lain - lain">Lain - lain</option>
</select>
</div>
<div class="col-md-3">
<label>Pekerjaan Ibu:</label>
<input class="form-control" type="text" name="pek_ibu" placeholder="Sebutkan Pendidikan Ibu" required/>
</div>
</div><br>
<div class="row">
<div class="col-md-3">
<label>Jabatan Pekerjaan Ayah:</label>
<input class="form-control" type="text" name="jab_ayah" placeholder="Tulis Jabatan Kerja Ayah" required/>
</div>
<div class="col-md-3">
<label>Alamat Kantor Ayah:</label>
<input class="form-control" type="text" name="alkan_ayah" placeholder="Tulis Alamat Kantor Ayah" required/>
</div>
<div class="col-md-3">
<label>Jabatan Pekerjaan Ibu:</label>
<input class="form-control" type="text" name="jab_ibu" placeholder="Tulis Jabatan Kerja Ibu" required/>
</div>
<div class="col-md-3">
<label>Alamat Kantor Ibu:</label>
<input class="form-control" type="text" name="alkan_ibu" placeholder="Tulis Alamat Kantor Ibu" required/>
</div>
</div><br>
<div class="row">
<div class="col-md-6">
<label>Nomor Telepon Ayah:</label>
<input class="form-control" type="text" name="telp_ayah" placeholder="Sebutkan Nomor Telepon Ayah" required/>
</div>
<div class="col-md-6">
<label>Nomor Telepon Ibu:</label>
<input class="form-control" type="text" name="telp_ibu" placeholder="Sebutkan Nomor Telepon Ibu" required/>
</div>
<div class="col-md-12">
<p> <i>*) Dianjurkan untuk Nomor Telepon yang Juga Menggunakan / Tersedia di Dalam Fitur Whatsapp</i> </p>
</div>
</div><br>
<div class="row">
<div class="col-md-3">
<label>Penghasilan Ayah Perbulan:</label>
<select class="form-control" name="gaji_ayah" required>
<option value="-">Pilih Penghasilan</option>
<option value="< 1 JT">< 1 JT</option>
<option value="1 - 3 JT">1 - 3 JT</option>
<option value="3 - 5 JT">3 - 5 JT</option>
<option value="> 5 JT">> 5 JT</option>
<option value="Lain - lain">Lain - lain</option>
</select>
</div>
<div class="col-md-3">
<label>dan Penghasilan Ibu Perbulan:</label>
<select class="form-control" name="gaji_ibu" required>
<option value="-">Pilih Penghasilan</option>
<option value="< 1 JT">< 1 JT</option>
<option value="1 - 3 JT">1 - 3 JT</option>
<option value="3 - 5 JT">3 - 5 JT</option>
<option value="> 5 JT">> 5 JT</option>
<option value="Lain - lain">Lain - lain</option>
</select>
</div>
<div class="col-md-3">
<label>Jarak Tempuh Menuju ke Sekolah:</label>
<select class="form-control" name="jarak" required>
<option value="-">Pilih Jarak</option>
<option value="0 - 1 Km">0 - 1 Km</option>
<option value="1 - 3 Km">1 - 3 Km</option>
<option value="3 - 5 Km">3 - 5 Km</option>
<option value="5 - 10 Km">5 - 10 Km</option>
<option value="Lebih dari 10 Km">Lebih dari 10 Km</option>
<option value="Lain - lain">Lain - lain</option>
</select>
</div>
<div class="col-md-3">
<label>Status Rumah Tinggal Anda:</label>
<select class="form-control" name="status_rumah" required>
<option value="-">Pilih Status</option>
<option value="Rumah Sendiri">Rumah Sendiri</option>
<option value="Rumah Sewa">Rumah Sewa</option>
<option value="Rumah Orang Tua">Rumah Orang Tua</option>
</select>
</div>
</div><br>
<div class="alert alert-info">
<strong>C. DATA BERKAS</strong>
</div>
<div class="row">
<div class="col-md-12">
<label>Lengkapi Data Berkas Berikut Ini:</label>
</div><br>
<div class="col-md-12" style="padding-top: 20px;">
<div class="col-md-6">
<label>Scan Kartu Keluarga</label>
<p style="color: red">*) Contoh:</p>
<div class="avatar">
<img src="images/kk.jpg" alt="Thumbnail Image" class="img-thumbnail img-responsive" width="45%">
</div><br>
<input type="file" name="kk" id="fileToUpload" accept="image/*" required><br>
</div>
<div class="col-md-6">
<label>Scan Akte Kelahiran</label>
<p style="color: red">*) Contoh:</p>
<div class="avatar">
<img src="images/ak.jpg" alt="Thumbnail Image" class="img-thumbnail img-responsive" width="45%">
</div><br>
<input type="file" name="ak" id="fileToUpload" accept="image/*" required><br>
</div>
</div>
<div class="col-md-12" style="padding-top: 20px;">
<div class="col-md-6">
<label>Scan E-KTP Orang Tua</label>
<p style="color: red">*) Contoh:</p>
<div class="avatar">
<img src="images/ektp.jpg" alt="Thumbnail Image" class="img-thumbnail img-responsive" width="45%">
</div><br>
<input type="file" name="ektp" id="fileToUpload" accept="image/*" required><br>
</div>
<div class="col-md-6">
<label>Scan Surat Keterangan Asal Sekolah</label>
<p style="color: red">*) Contoh:</p>
<div class="avatar">
<img src="images/skas.jpg" alt="Thumbnail Image" class="img-thumbnail img-responsive" width="45%">
</div><br>
<input type="file" name="skas" id="fileToUpload" accept="image/*" required><br>
</div>
</div>
</div><br>
<div class="col-md-12">
<label>Foto</label>
<p style="color: red">*) Contoh </p>
<div class="avatar">
<img src="images/pass.png" alt="Thumbnail Image" class="img-thumbnail img-responsive" width="15%">
</div><br>
<input type="file" name="foto" id="fileToUpload" accept="image/*" required><br>
<div class="row">
<div class="col-md-2">
<label><input type="checkbox" required=""> Setuju</label>
</div>
<div class="col-md-9">
<ul>
<li>Saya telah mengisi data dengan sebenar-benarnya dan dapat dipertanggungjawabkan;</li>
<li>Jika data tidak terverifikasi terhitung dalam waktu 1x24 jam, silahkan hubungi pihak panitia pendaftaran siswa online di nomor : 0877-8837-2748;</li>
<li>Saya telah mengingat atau mencatat password untuk login nanti setelah formulir dikirimkan.</li>
</ul>
</div>
</div><br>
<div class="row" align="center">
<div class="edu_button">
<input type="submit" name="submit" class="btn btn-primary hvr-underline-from-center" value="Kirimkan Formulir Saya">
</div>
</div>
</div><br>
</form>
</div>
</div>
</div>
<div class="contact-footer-w3layouts-agile">
<?php include "media.php" ?>