Bursluluk Sınavı

<form action="/tr/form/4/15" enctype="multipart/form-data" method="post"><input name="security1" type="hidden" value="125" />
<div class="row mb50 mb-5">
<div class="col-lg-12">
<h2>Öğrenci Bilgileri</h2>
</div>

<div class="col-lg-6"><input class="form-control" name="form_1" placeholder="Adı :" required="" type="text" /></div>

<div class="col-lg-6"><input class="form-control" name="form_2" placeholder="Soyadı :" required="" type="text" /></div>

<div class="col-lg-12"><input class="form-control" name="form_3" placeholder="Öğrencinin TC Kimlik No :" required="" type="text" /></div>

<div class="col-lg-6"><input class="form-control" name="form_4" placeholder="gg.aa.yyyy" required="" type="text" /></div>

<div class="col-lg-6"><select class="form-control" name="form_5" required="required"><option disabled="disabled" selected="selected" value="">Cinsiyet Seçiniz</option><option value="Erkek ">Erkek</option><option value="Kız ">Kız</option> </select></div>

<div class="col-lg-4"><input class="form-control" name="form_6" placeholder="Devam Ettiği Okul :" required="" type="text" /></div>

<div class="col-lg-4"><input class="form-control" name="form_7" placeholder="Seneye Okuyacağı Sınıf :" required="" type="text" /></div>

<div class="col-lg-4"><select class="form-control" name="form_8" required="required"><option disabled="disabled" selected="selected" value="">Kayıt Olmak İstediğiniz Şubemizi Seçiniz</option><option value="Antalya ">Antalya</option> </select></div>

<div class="col-lg-12">
<h2>Veli Bilgileri</h2>
</div>

<div class="col-lg-4"><input class="form-control" name="form_9" placeholder="Adı :" required="" type="text" /></div>

<div class="col-lg-4"><input class="form-control" name="form_10" placeholder="Soyadı :" required="" type="text" /></div>

<div class="col-lg-4"><select class="form-control" name="form_11" required="required"><option disabled="disabled" selected="selected" value="">Yakınlık Derecesi</option><option value="Anne ">Anne</option><option value="Baba ">Baba</option><option value="Akraba ">Akraba</option><option value="Diğer ">Diğer</option> </select></div>

<div class="col-lg-4"><input class="form-control" name="form_12" placeholder="Cep Telefonu :" required="" type="text" /></div>

<div class="col-lg-4"><input class="form-control" name="form_13" placeholder="Ev Telefonu :" required="" type="text" /></div>

<div class="col-lg-4"><input class="form-control" name="form_14" placeholder="İş Telefonu :" required="" type="text" /></div>

<div class="col-lg-6"><input class="form-control" name="mail" placeholder="E-Posta Adresiniz :" required="" type="email" /></div>

<div class="col-lg-6"><input class="form-control" name="security2" placeholder="Güvenlik Sorusu : 85 + 40 = ?" required="" value="" /></div>

<div class="col-lg-12"><textarea class="form-control" col="25" cols="20" name="form_15" placeholder="Açıklama" required="required" rows="5"></textarea></div>

<div class="col-lg-12 text-center"><button type="submit">Gönder</button></div>
</div>
</form>

http://www.antalyayukselisokullari.com/tr/bursluluk-sinav.html