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health_center.html
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health_center.html
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<!DOCTYPE html>
<html lang="en">
<head>
<meta charset="utf-8">
<meta http-equiv="X-UA-Compatible" content="IE=edge">
<meta name="viewport" content="width=device-width, initial-scale=1">
<title>Obafemi Awolowo university Portal - Home</title>
<!-- Styleheets -->
<link rel="stylesheet" href="fontawesome/css/fontawesome-all.min.css">
<link rel="stylesheet" href="css/bootstrap.css">
<link rel="stylesheet" href="css/styles.css">
<link rel="icon" href="img/oaulogo.png" type="image/png" sizes="16x16">
<!-- Scripts -->
<script type="text/javascript" src="js/jquery.js"></script>
<script type="text/javascript" src="js/bootstrap.js"></script>
<script type="text/javascript" src="js/script.js"></script>
</head>
<body>
<header>
<div class="container">
<div class="row desktop">
<div class="col-md-2 col-sm-2">
<img src="img/oaulogo.png" alt="OAU LOGO" class="logo">
</div>
<div class="col-md-10 col-sm-10">
<span class="sitename">
Obafemi Awolowo University Student
<br>
Information Portal
</span>
</div>
</div>
<div class="row mobile">
<div class="col-xs-12">
<a role="button" href="#menu" onclick="open_menu()" class="btn pull-left btn-primary">
<i class="fas fa-bars"></i>
</a>
<ul class="pull-right">
<li><a role="button" href="login.html" class="btn btn-warning">Login</a></li>
</ul>
<div>
<a href="home.html">
<img src="img/oaulogo.png" alt="" class="">
<span class="sitename">OAU
<!-- <small><small>Information Portal</small></small> -->
</span>
</a>
</div>
</div>
</div>
</div>
</header>
<nav class="desktop navbar navbar-inverse">
<div class="container-fluid">
<!-- Brand and toggle get grouped for better mobile display -->
<div class="navbar-header">
<button type="button" class="navbar-toggle collapsed" data-toggle="collapse" data-target="#bs-example-navbar-collapse-1" aria-expanded="false">
<span class="sr-only">Toggle navigation</span>
<span class="icon-bar"></span>
<span class="icon-bar"></span>
<span class="icon-bar"></span>
</button>
</div>
<!-- Collect the nav links, forms, and other content for toggling -->
<div class="collapse navbar-collapse" id="bs-example-navbar-collapse-1">
<ul class="nav navbar-nav">
<li class="active"><a href="home.html">Home</a></li>
<li class="dropdown">
<a href="#" class="dropdown-toggle" data-toggle="dropdown" role="button" aria-haspopup="true" aria-expanded="false">Students <span class="caret"></span></a>
<ul class="dropdown-menu">
<li><a href="login.html">Undergraduate</a></li>
<li role="separator" class="divider"></li>
<li><a href="login.html">Postgraduate</a></li>
<li role="separator" class="divider"></li>
<li><a href="login.html">Executive MBA</a></li>
</ul>
</li>
<li class="dropdown">
<a href="#" class="dropdown-toggle" data-toggle="dropdown" role="button" aria-haspopup="true" aria-expanded="false">Staff <span class="caret"></span></a>
<ul class="dropdown-menu">
<li><a href="login.html">Staff Login</a></li>
<li role="separator" class="divider"></li>
<li><a href="#">Bursary</a></li>
</ul>
</li>
<li><a href="">FAQs</a></li>
<li><a href="">Contact Us</a></li>
</ul>
<ul class="nav navbar-nav navbar-right">
<li class="dropdown">
<a href="#" class="dropdown-toggle" data-toggle="dropdown" role="button" aria-haspopup="true" aria-expanded="false">Welcome guest <span class="caret"></span></a>
<ul class="dropdown-menu">
<!-- <li role="separator" class="divider"></li> -->
<!-- This is displayed when not logged in -->
<li><a href="#">Login</a></li>
<!-- This is displayed when logged in -->
<!-- <li><a href="#">Sign Out</a></li> -->
</ul>
</li>
</ul>
</div><!-- /.navbar-collapse -->
</div><!-- /.container-fluid -->
</nav>
<nav id="mobile_menu" class="mobile">
<div class="container">
<div class="row">
<div class="">
<p class="nav_top">
<span">Menu</span>
<span class="close_button">
<a href="#" onclick="close_mobile_menu()">
<i class="fas fa-times"></i>
</a>
</span>
</p>
<!-- this is displayed when not logged in -->
<ul class="links logged_out">
<li><a href="home.html">Home</a></li>
<li>
<a href="#" class="" onclick="drop_menu()">Students <span class="fas fa-chevron-right pull-right"></span></a>
<ul id="drop" class="drop">
<li><a href="login.html">Undergraduate</a></li>
<li role="separator" class="divider"></li>
<li><a href="login.html">Postgraduate</a></li>
<li role="separator" class="divider"></li>
<li><a href="login.html">Executive MBA</a></li>
</ul>
</li>
<li>
<a href="#" class="" onclick="drop_menu()">Staff <span class="fas fa-chevron-right pull-right"></span></a>
<ul id="drop" class="drop">
<li><a href="">Payment via Remita</a></li>
<li><a href="">View Payment Status</a></li>
<li><a href="">Download Payment Slip for Cash Office</a></li>
</ul>
</li>
<li><a href="#">FAQs</a></li>
<li><a href="contact.html">Contact Us</a></li>
<li class="login"><a href="login.html">Login <i class="fas fa-sign-in-alt"></i></a></li>
</ul>
<!-- This is displayed when logged in -->
<ul class="links logged_in">
<li><a href="profile.html" class="">Profile Page</a></li>
<li><a href="#" class="">Health Centre Registration</a></li>
<li><a href="#">Teaching Assessment</a></li>
<li>
<a href="#" class="" onclick="drop_menu()">Payment Activities <span class="fas fa-chevron-right pull-right"></span></a>
<ul id="drop" class="drop">
<li><a href="">Payment via Remita</a></li>
<li><a href="">View Payment Status</a></li>
<li><a href="">Download Payment Slip for Cash Office</a></li>
</ul>
</li>
<li><a href="#" class="">Complete Certificate Form</a></li>
<li><a href="#" class="">Online Screening</a></li>
<li><a href="#" class="">Check Admission Status</a></li>
<li><a href="#" class="">Activate Late Reg. Payment</a></li>
<li><a href="#" class="">Update Biodata Information</a></li>
<li><a href="#" class="">Register Courses</a></li>
<li><a href="#" class="">Complete Health Centre Form</a></li>
<li><a href="#" class="">View Semester Raw Score</a></li>
<li><a href="#" class="">Check Result</a></li>
<li><a href="#" class="">Check Messages</a></li>
<li>
<a href="#" class="">Bedspace Request <span class="fas fa-chevron-right pull-right"></span></a>
<ul id="drop" class="drop">
<li><a href="#">Information on Accomodation</a></li>
<li><a href="#">Freshers Bedspace request</a></li>
<li><a href="#">Year 2 Bedspace Request</a></li>
<li><a href="#">Year 3 Bedspace Request</a></li>
<li><a href="#">Final Year Bedspace Request</a></li>
</ul>
</li>
<li>
<a href="#" class="">Reports <span class="fas fa-chevron-right pull-right"></span></a>
<ul id="drop" class="drop">
<li><a href="#">Basic Rules/Regulations in Halls of Residence</a></li>
<li><a href="#">Accommodation Agreement Form</a></li>
<li><a href="#">Bedspace Clearance</a></li>
<li><a href="#">Course Registration</a></li>
<li><a href="#">Clearance Certificate</a></li>
</ul>
</li>
<li>
<a href="#" class="">Documentations <span class="fas fa-chevron-right pull-right"></span></a>
<ul id="drop" class="drop">
<li><a href="#">Registration Infomation and Fees Breakdown</a></li>
</ul>
</li>
<li><a href="#" class="">Contact Councellor</a></li>
<li><a href="#" class="">Change Password</a></li>
<li><a href="login.html" class="">Sign out</a></li>
</ul>
</div>
</div>
</div>
</nav>
<section id="login_page">
<div class="container">
<div class="row">
<div class="col-md-8 col-md-offset-2 col-sm-8 col-sm-offset-2 col-xs-12 col-xs-offset-0">
<h3 class="text-center">STUDENT MEDICAL ENTRANCE FORM</h3>
<form class="form-horizontal" method="POST" action="profile.html" name="biodata">
<div class="form-group">
<label class="col-md-12 col-sm-12 col-xs-12" for="title">Bio-Data</label>
</div>
<div class="form-group">
<label class="col-md-3 col-sm-2 col-xs-12" for="title">UTME No:</label>
<div class="col-md-9 col-sm-10 col-xs-12">
<input class="form-control" name="umepdp" type="text" id="umepdp">
</div>
</div>
<div class="form-group">
<label class="col-md-3 col-sm-2 col-xs-12" for="title">Matric No:</label>
<div class="col-md-9 col-sm-10 col-xs-12">
<input class="form-control" name="regno" type="text" id="regno"">
</div>
</div>
<div class="form-group">
<label class="col-md-3 col-sm-2 col-xs-12" for="title">Health Centre No:</label>
<div class="col-md-9 col-sm-10 col-xs-12">
<input class="form-control" name="hcno" type="text" placeholder="(New Sudents: Enter NIL)">
</div>
</div>
<div class="form-group">
<label class="col-md-3 col-sm-2 col-xs-12" for="title">Title:</label>
<div class="col-md-9 col-sm-10 col-xs-12">
<select class="form-control" name="title" id="title">
<option value="MISS" selected="selected">MISS</option>
<option value="MR" selected="selected">MR</option>
<option value="DR" selected="selected">DR</option>
<option value="MRS" selected="selected">MRS</option>
<option value="MR" selected="selected">MR</option>
</select>
</div>
</div>
<div class="form-group">
<label class="col-md-3 col-sm-2 col-xs-12" for="title">Other Names</label>
<div class="col-md-9 col-sm-10 col-xs-12">
<input class="form-control" name="othername" type="text" id="othername">
</div>
</div>
<div class="form-group">
<label class="col-md-3 col-sm-2 col-xs-12" for="title">Hall Address</label>
<div class="col-md-9 col-sm-10 col-xs-12">
<input class="form-control" name="halladdr" type="text" id="halladdr" value="NIL">
</div>
</div>
<div class="form-group">
<label class="col-md-3 col-sm-2 col-xs-12" for="title">Home Address</label>
<div class="col-md-9 col-sm-10 col-xs-12">
<input class="form-control" name="homeadd" type="text" id="homeadd">
</div>
</div>
<div class="form-group">
<label class="col-md-3 col-sm-2 col-xs-12" for="title">Tribe</label>
<div class="col-md-9 col-sm-10 col-xs-12">
<input class="form-control" name="tribe" type="text" id="tribe">
</div>
</div>
<div class="form-group">
<label class="col-md-3 col-sm-2 col-xs-12" for="title">State</label>
<div class="col-md-9 col-sm-10 col-xs-12">
<input class="form-control" name="state" type="text" id="state">
</div>
</div>
<div class="form-group">
<label class="col-md-3 col-sm-2 col-xs-12" for="title">Place of Origin</label>
<div class="col-md-9 col-sm-10 col-xs-12">
<input class="form-control" name="place" type="text" id="place">
</div>
</div>
<div class="form-group">
<label class="col-md-3 col-sm-2 col-xs-12" for="title">Country</label>
<div class="col-md-9 col-sm-10 col-xs-12">
<input class="form-control" name="nation" type="text" id="nation">
</div>
</div>
<div class="form-group">
<label class="col-md-3 col-sm-2 col-xs-12" for="title">Religion/Denomination</label>
<div class="col-md-9 col-sm-10 col-xs-12">
<input class="form-control" name="reldenom" type="text" id="reldenom">
</div>
</div>
<div class="form-group">
<label class="col-md-3 col-sm-2 col-xs-12" for="title">Sex</label>
<div class="col-md-9 col-sm-10 col-xs-12">
<select class="form-control" name="sex" id="sex">
<option value="Male" selected="selected">Male</option>
<option value="Female">Female</option>
<option value="Male" selected="selected">Male</option>
</select>
</div>
</div>
<div class="form-group">
<label class="col-md-3 col-sm-2 col-xs-12" for="title">Marital Status</label>
<div class="col-md-9 col-sm-10 col-xs-12">
<select class="form-control" name="mstatus" id="mstatus">
<option value="Single" selected="selected">Single</option>
<option value="Married">Married</option>
<option value="Single" selected="selected">Single</option>
</select>
</div>
</div>
<div class="form-group">
<label class="col-md-3 col-sm-2 col-xs-12" for="title">Mobile Number</label>
<div class="col-md-9 col-sm-10 col-xs-12">
<input class="form-control" name="phone" type="text" id="phone" maxlength="11">
</div>
</div>
<div class="form-group">
<label class="col-md-3 col-sm-2 col-xs-12" for="title">Faculty</label>
<div class="col-md-9 col-sm-10 col-xs-12">
<input class="form-control" name="faculty" type="text" id="faculty">
</div>
</div>
<div class="form-group">
<label class="col-md-3 col-sm-2 col-xs-12" for="title">Department</label>
<div class="col-md-9 col-sm-10 col-xs-12">
<input class="form-control" name="dept" type="text" id="dept">
</div>
</div>
<div class="form-group">
<label class="col-md-3 col-sm-2 col-xs-12" for="title">Birthdate</label>
<div class="col-md-9 col-sm-10 col-xs-12">
<input class="form-control" name="birthdate" type="text" id="birthdate" maxlength="10">
dd/mm/yyyy
</div>
</div>
<div class="form-group">
<label class="col-md-3 col-sm-2 col-xs-12" for="title">Class</label>
<div class="col-md-9 col-sm-10 col-xs-12">
<select class="form-control" name="class" id="class">
<option value="Undergraduate" selected="selected">Undergraduate</option>
<option value="Graduate">Graduate</option>
<option value="Undergraduate" selected="selected">Undergraduate</option>
</select>
</div>
</div>
<div class="form-group">
<label class="col-md-12 col-sm-12 col-xs-12" for="title">Next of Kin: Parent/Guardian</label>
</div>
<div class="form-group">
<label class="col-md-3 col-sm-2 col-xs-12" for="title">Name</label>
<div class="col-md-9 col-sm-10 col-xs-12">
<input class="form-control" name="pgname" type="text" id="pgname">
</div>
</div>
<div class="form-group">
<label class="col-md-3 col-sm-2 col-xs-12" for="title">Address</label>
<div class="col-md-9 col-sm-10 col-xs-12">
<input class="form-control" name="pgaddress" type="text" id="pgaddress">
</div>
</div>
<div class="form-group">
<label class="col-md-3 col-sm-2 col-xs-12" for="title">Relationship</label>
<div class="col-md-9 col-sm-10 col-xs-12">
<select class="form-control" name="pgrelation" id="pgrelation">
<option value="Spouse" selected="selected">Spouse</option>
<option value="Parents" selected="selected">Parents</option>
<option value="Sister" selected="selected">Sister</option>
<option value="Brother" selected="selected">Brother</option>
<option value="Cousin" selected="selected">Cousin</option>
<option value="Guardian" selected="selected">Guardian</option>
<option value="Parents" selected="selected">Parents</option>
</select>
</div>
</div>
<div class="form-group">
<label class="col-md-3 col-sm-2 col-xs-12" for="title">Contact Number</label>
<div class="col-md-9 col-sm-10 col-xs-12">
<input class="form-control" name="pgphone" type="text" id="pgphone">
</div>
</div>
<div class="form-group">
<label class="col-md-12 col-sm-12 col-xs-12" for="title">Access (this guarantees your continuous access to updating registration information)</label>
</div>
<div class="form-group">
<label class="col-md-3 col-sm-2 col-xs-12" for="title">Username</label>
<div class="col-md-9 col-sm-10 col-xs-12">
<input class="form-control" name="username" type="text" id="username">
</div>
</div>
<div class="form-group">
<div class="col-md-offset-3 col-sm-offset-2 col-xs-offset-4">
<button type="submit" class="btn btn-warning" name="button">Submit</button>
</div>
</div>
<input type="hidden" value="biodata">
</form>
</div>
</div>
</div>
</section>
<footer class="funny_footer">
<div class="container">
<div class="row text-center">
<div class="col-md-12">
<span class="footer"><i class="far fa-copyright"></i> 2006 - 2018 Obafemi Awolowo University</span>
</div>
</div>
</div>
</footer>
</body>
</html>