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index.html
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<html lang="en" dir="ltr">
<head>
<meta charset="utf-8">
<title>Survey form</title>
<link rel="stylesheet" href="css/styles.css">
</head>
<div id="outside" class="top">
<form id="survey-form" action="index.html" method="post">
<h1 style="text-align:center">Application to be my Boyfriend</h1>
<p style="text-align:center" class="note"><b>Note:</b> Be honest while filling out the form!!</p>
<body>
<fieldset>
<legend class="title"><b>Personal Details</b></legend><br>
<div>
<label>Name:</label>
<input type="text" name="YourName" value="" id="name" placeholder="enter your name" required>
</div><br>
<div>
<label>Address:</label>
<input type="text" name="YourAddress" value="" id="Address" placeholder="enter your address" required>
</div><br>
<div>
<label>Email:</label>
<input type="email" name="YourEmail" value="" id="email" placeholder="enter your email" required>
</div><br>
<div>
<label id="number-label" for="phone">Phone Number:</label>
<input type="number" id="number" name="user_name" placeholder="Enter 10 digit number" min="1" max="9" required>
</div><br>
<div>
<label>Age:</label>
<input type="text" name="YourAge" value="" id="age" placeholder="enter your age" required>
</div><br>
<div class="form-control">
<label>IQ:</label>
<input type="text" name="YourIQ" value="" id="iq" placeholder="enter your IQ" required>
</div><br>
<div>
<label>Gender:</label>
<select name="Gender" id="gender">
<option value="">--Please choose an option--</option>
<option value="male">Male</option>
<option value="female">Female</option>
</select>
</div><br>
<div>
<label>Date of proposed outing:</label>
<input type="date" name="YourDate" value="" id="date" placeholder="enter the date" required>
</div>
</fieldset>
<br>
<fieldset>
<div>
<label class="apply"><b>Check all that Apply</b></label>
<p>
<input type="checkbox">I have a pet dog <br>
<input type="checkbox">I like to eat chappathi <br>
<input type="checkbox">I love to travel <br>
<input type="checkbox">I work full time and I am rich <br>
<input type="checkbox">I can buy you luxury products <br>
</p>
</div>
</fieldset>
<br>
<fieldset>
<div>
<label>Educational Level:</label>
<select id="dropdown2">
<option value="">--select--</option>
<option value="University">University</option>
<option value="College">College</option>
<option value="Secondary">High School</option>
<option value="None">None</option>
</select>
</div>
</fieldset>
<br>
<fieldset>
<legend class="title"><b>Essay Section</b></legend>
<div>
<p>In 50 words or more explain why you want to be my Boyfriend?</p>
<textarea id="msg" name="user_message" rows="4" cols="50" placeholder="Enter Text Here"></textarea> </div>
<div>
<p>Please upload contact details of 2 references here:</p>
<textarea id="msg2" name="user_message" rows="4" cols="50" placeholder="Enter Text Here"></textarea> </div>
<p>Upload a natural Picture without filter, Bank statment and Job offer letter here:
<input type="file" id="actual-btn"/>
</fieldset>
<br>
<div style="text-align:center">
<button type="submit" id="submit">Send your application</button>
</div>
</body>
</form>
</div>
</html>