

<style>
    .icon-password{
        position: relative;
        display: table;
        border-collapse: separate;
    }
    label.error{
        position: absolute;
    }
</style>
<?= $this->element('page_top', array('title' => __('Add Feedback'), 'permissions' => $user_permission)); ?>

        <div class="container-fluid box box-primary">
            <?= $this->Form->create(null, ['id' => 'student_form', 'class'=> 'input-form-section']) ?>
        <!-- /.box-header -->
        <div class="box-body">
            <div class="col-12 ">
                <h4 class="text-center rounded text-white fw-bold pt-1 pb-1 hd-line-height"
                    style="background:#ccc">
                    <b>Course Information</b>
                </h4>
            </div>
            <div class="row form-group">
                <div class="col-md-6">

                        <label for="course_id" class="control-label d-block">Applied Course:<span
                                    class="text-danger">*</span></label>
                        <select required name="course_id" id="course_id" class="form-control">
                            <option selected="" disabled="" value="">Select One</option>
                            <?php foreach ($courses as $id => $name): ?>
                                <option value="<?= h($id) ?>"><?= h($name) ?></option>
                            <?php endforeach; ?>
                        </select>

                </div>
                <div class="col-md-6">

                        <label for="session_id" class="control-label d-block">Session:<span
                                    class="text-danger">*</span></label>
                        <select required name="session_id" id="session_id" class="form-control">
                            <option selected="" disabled="" value="">Select One</option>
                            <?php foreach ($sessions as $id => $name): ?>
                                <option value="<?= h($id) ?>"><?= h($name) ?></option>
                            <?php endforeach; ?>
                        </select>

                </div>
            </div>
            <div class="col-12 ">
                <h4 class="text-center rounded text-white fw-bold pt-1 pb-1 hd-line-height"
                    style="background:#ccc">
                    <b>Basic Information</b>
                </h4>
            </div>
            <div class="row form-group">
                <div class="col-md-4 mb-1">
                    <label for="title" class="control-label">Title<span
                                class="text-danger">*</span></label>
                    <!-- <input required type="text" name="title" id="title" class="form-control" placeholder="Title"> -->
                    <select required name="title" id="title" class="form-control">
                        <option selected="" disabled="" value="">Select One</option>
                        <option value="Mr">Mr</option>
                        <option value="Ms">Ms</option>
                        <option value="Mrs">Mrs</option>
                        <option value="Miss">Miss</option>
                        <option value="Dr">Dr</option>
                    </select>
                </div>
                <div class="col-md-4 mb-1">
                    <label for="first_name" class="control-label">First Name<span
                                class="text-danger">*</span></label>
                    <input required type="text" name="first_name" id="first_name"
                           class="form-control" placeholder="First Name">
                </div>
                <div class="col-md-4 mb-1">
                    <label for="surname" class="control-label">Surname<span
                                class="text-danger">*</span></label>
                    <input required type="text" name="surname" id="surname"
                           class="form-control" placeholder="Surname">
                </div>
            </div>

            <div class="row form-group">
                <div class="col-md-6">
                    <label for="date_of_birth" class="control-label d-block">Date of Birth<span
                                class="text-danger">*</span></label>
                    <div class="row">
                        <div class="col-md-4 mb-1">
                            <select required name="date_day" id="day_of_birth" class="form-control">
                                <option selected="" disabled="" value="">Day</option>
                                <option value="01">01</option>
                                <option value="02">02</option>
                                <option value="03">03</option>
                                <option value="04">04</option>
                                <option value="05">05</option>
                                <option value="06">06</option>
                                <option value="07">07</option>
                                <option value="08">08</option>
                                <option value="09">09</option>
                                <option value="10">10</option>
                                <option value="11">11</option>
                                <option value="12">12</option>
                                <option value="13">13</option>
                                <option value="14">14</option>
                                <option value="15">15</option>
                                <option value="16">16</option>
                                <option value="17">17</option>
                                <option value="18">18</option>
                                <option value="19">19</option>
                                <option value="20">20</option>
                                <option value="21">21</option>
                                <option value="22">22</option>
                                <option value="23">23</option>
                                <option value="24">24</option>
                                <option value="25">25</option>
                                <option value="26">26</option>
                                <option value="27">27</option>
                                <option value="28">28</option>
                                <option value="29">29</option>
                                <option value="30">30</option>
                                <option value="31">31</option>
                            </select>
                            <span class="help-inline"></span>
                        </div>
                        <div class="col-md-4 mb-1">
                            <select required name="date_month" id="month_of_birth" class="form-control">
                                <option selected="" disabled="" value="">Month</option>
                                <option value="01">January</option>
                                <option value="02">February</option>
                                <option value="03">March</option>
                                <option value="04">April</option>
                                <option value="05">May</option>
                                <option value="06">June</option>
                                <option value="07">July</option>
                                <option value="08">August</option>
                                <option value="09">September</option>
                                <option value="10">October</option>
                                <option value="11">November</option>
                                <option value="12">December</option>
                            </select>
                        </div>
                        <div class="col-md-4 mb-1">
                            <select required name="date_year" id="year_of_birth" class="form-control">
                                <option disabled="" selected="" value="">Year</option>
                                <option value="1970">1970</option>
                                <option value="1971">1971</option>
                                <option value="1972">1972</option>
                                <option value="1973">1973</option>
                                <option value="1974">1974</option>
                                <option value="1975">1975</option>
                                <option value="1976">1976</option>
                                <option value="1977">1977</option>
                                <option value="1978">1978</option>
                                <option value="1979">1979</option>
                                <option value="1980">1980</option>
                                <option value="1981">1981</option>
                                <option value="1982">1982</option>
                                <option value="1983">1983</option>
                                <option value="1984">1984</option>
                                <option value="1985">1985</option>
                                <option value="1986">1986</option>
                                <option value="1987">1987</option>
                                <option value="1988">1988</option>
                                <option value="1989">1989</option>
                                <option value="1990">1990</option>
                                <option value="1991">1991</option>
                                <option value="1992">1992</option>
                                <option value="1993">1993</option>
                                <option value="1994">1994</option>
                                <option value="1995">1995</option>
                                <option value="1996">1996</option>
                                <option value="1997">1997</option>
                                <option value="1998">1998</option>
                                <option value="1999">1999</option>
                                <option value="2000">2000</option>
                                <option value="2001">2001</option>
                                <option value="2002">2002</option>
                                <option value="2003">2003</option>
                                <option value="2004">2004</option>
                                <option value="2005">2005</option>
                                <option value="2006">2006</option>
                                <option value="2007">2007</option>
                                <option value="2008">2008</option>
                                <option value="2009">2009</option>
                                <option value="2010">2010</option>
                                <option value="2011">2011</option>
                                <option value="2012">2012</option>
                                <option value="2013">2013</option>
                                <option value="2014">2014</option>
                                <option value="2015">2015</option>
                                <option value="2016">2016</option>
                                <option value="2017">2017</option>
                                <option value="2018">2018</option>
                                <option value="2019">2019</option>
                                <option value="2020">2020</option>
                                <option value="2021">2021</option>
                                <option value="2022">2022</option>
                                <option value="2023">2023</option>
                                <option value="2024">2024</option>
                                <option value="2025">2025</option>
                                <option value="2026">2026</option>
                                <option value="2027">2027</option>
                                <option value="2028">2028</option>
                                <option value="2029">2029</option>
                                <option value="2030">2030</option>

                            </select>
                        </div>
                    </div>
                </div>
                <div class="col-md-6">
                    <label for="birth_place" class="control-label">Place of Birth<span
                                class="text-danger">*</span></label>
                    <input required type="text" name="birth_place" id="birth_place"
                           class="form-control" placeholder="Place of Birth">
                </div>
            </div>

            <div class="row form-group">
                <div class="col-md-4 mb-1">
                    <label for="gender" class="control-label d-block">Gender<span
                                class="text-danger">*</span></label>
                    <select required name="gender" id="gender" class="form-control">
                        <option selected="" disabled="" value="">Select One</option>
                        <option value="Male">Male</option>
                        <option value="Female">Female</option>
                        <option value="Female">Other</option>
                    </select>
                </div>
                <div class="col-md-4 mb-1 ">
                    <div class="form-group">
                        <label for="nationality" class="control-label  d-block">Nationality<span
                                    class="text-danger">* </span></label>
                        <select required name="nationality" id="nationality"
                                class="form-control">
                            <option selected="" disabled="" value="">Select One</option>
                            <option value="Afghanistan">Afghanistan</option>
                            <option value="Åland Islands">Åland Islands</option>
                            <option value="Albania">Albania</option>
                            <option value="Algeria">Algeria</option>
                            <option value="American Samoa">American Samoa</option>
                            <option value="Andorra">Andorra</option>
                            <option value="Angola">Angola</option>
                            <option value="Anguilla">Anguilla</option>
                            <option value="Antarctica">Antarctica</option>
                            <option value="Antigua and Barbuda">Antigua and Barbuda</option>
                            <option value="Argentina">Argentina</option>
                            <option value="Armenia">Armenia</option>
                            <option value="Aruba">Aruba</option>
                            <option value="Australia">Australia</option>
                            <option value="Austria">Austria</option>
                            <option value="Azerbaijan">Azerbaijan</option>
                            <option value="Bahamas">Bahamas</option>
                            <option value="Bahrain">Bahrain</option>
                            <option value="Bangladesh">Bangladesh</option>
                            <option value="Barbados">Barbados</option>
                            <option value="Belarus">Belarus</option>
                            <option value="Belgium">Belgium</option>
                            <option value="Belize">Belize</option>
                            <option value="Benin">Benin</option>
                            <option value="Bermuda">Bermuda</option>
                            <option value="Bhutan">Bhutan</option>
                            <option value="Bolivia">Bolivia</option>
                            <option value="Bosnia and Herzegovina">Bosnia and Herzegovina
                            </option>
                            <option value="Botswana">Botswana</option>
                            <option value="Bouvet Island">Bouvet Island</option>
                            <option value="Brazil">Brazil</option>
                            <option value="British Indian Ocean Territory">British Indian Ocean
                                Territory
                            </option>
                            <option value="Brunei Darussalam">Brunei Darussalam</option>
                            <option value="Bulgaria">Bulgaria</option>
                            <option value="Burkina Faso">Burkina Faso</option>
                            <option value="Burundi">Burundi</option>
                            <option value="Cambodia">Cambodia</option>
                            <option value="Cameroon">Cameroon</option>
                            <option value="Canada">Canada</option>
                            <option value="Cape Verde">Cape Verde</option>
                            <option value="Cayman Islands">Cayman Islands</option>
                            <option value="Central African Republic">Central African Republic
                            </option>
                            <option value="Chad">Chad</option>
                            <option value="Chile">Chile</option>
                            <option value="China">China</option>
                            <option value="Christmas Island">Christmas Island</option>
                            <option value="Cocos (Keeling) Islands">Cocos (Keeling) Islands
                            </option>
                            <option value="Colombia">Colombia</option>
                            <option value="Comoros">Comoros</option>
                            <option value="Congo">Congo</option>
                            <option value="Congo, The Democratic Republic of The">Congo, The
                                Democratic
                                Republic of The</option>
                            <option value="Cook Islands">Cook Islands</option>
                            <option value="Costa Rica">Costa Rica</option>
                            <option value="Cote D'ivoire">Cote D'ivoire</option>
                            <option value="Croatia">Croatia</option>
                            <option value="Cuba">Cuba</option>
                            <option value="Cyprus">Cyprus</option>
                            <option value="Czech Republic">Czech Republic</option>
                            <option value="Denmark">Denmark</option>
                            <option value="Djibouti">Djibouti</option>
                            <option value="Dominica">Dominica</option>
                            <option value="Dominican Republic">Dominican Republic</option>
                            <option value="Ecuador">Ecuador</option>
                            <option value="Egypt">Egypt</option>
                            <option value="El Salvador">El Salvador</option>
                            <option value="Equatorial Guinea">Equatorial Guinea</option>
                            <option value="Eritrea">Eritrea</option>
                            <option value="Estonia">Estonia</option>
                            <option value="Ethiopia">Ethiopia</option>
                            <option value="Falkland Islands (Malvinas)">Falkland Islands
                                (Malvinas)</option>
                            <option value="Faroe Islands">Faroe Islands</option>
                            <option value="Fiji">Fiji</option>
                            <option value="Finland">Finland</option>
                            <option value="France">France</option>
                            <option value="French Guiana">French Guiana</option>
                            <option value="French Polynesia">French Polynesia</option>
                            <option value="French Southern Territories">French Southern
                                Territories</option>
                            <option value="Gabon">Gabon</option>
                            <option value="Gambia">Gambia</option>
                            <option value="Georgia">Georgia</option>
                            <option value="Germany">Germany</option>
                            <option value="Ghana">Ghana</option>
                            <option value="Gibraltar">Gibraltar</option>
                            <option value="Greece">Greece</option>
                            <option value="Greenland">Greenland</option>
                            <option value="Grenada">Grenada</option>
                            <option value="Guadeloupe">Guadeloupe</option>
                            <option value="Guam">Guam</option>
                            <option value="Guatemala">Guatemala</option>
                            <option value="Guernsey">Guernsey</option>
                            <option value="Guinea">Guinea</option>
                            <option value="Guinea-bissau">Guinea-bissau</option>
                            <option value="Guyana">Guyana</option>
                            <option value="Haiti">Haiti</option>
                            <option value="Heard Island and Mcdonald Islands">Heard Island and
                                Mcdonald
                                Islands</option>
                            <option value="Holy See (Vatican City State)">Holy See (Vatican City
                                State)
                            </option>
                            <option value="Honduras">Honduras</option>
                            <option value="Hong Kong">Hong Kong</option>
                            <option value="Hungary">Hungary</option>
                            <option value="Iceland">Iceland</option>
                            <option value="India">India</option>
                            <option value="Indonesia">Indonesia</option>
                            <option value="Iran, Islamic Republic of">Iran, Islamic Republic of
                            </option>
                            <option value="Iraq">Iraq</option>
                            <option value="Ireland">Ireland</option>
                            <option value="Isle of Man">Isle of Man</option>
                            <option value="Israel">Israel</option>
                            <option value="Italy">Italy</option>
                            <option value="Jamaica">Jamaica</option>
                            <option value="Japan">Japan</option>
                            <option value="Jersey">Jersey</option>
                            <option value="Jordan">Jordan</option>
                            <option value="Kazakhstan">Kazakhstan</option>
                            <option value="Kenya">Kenya</option>
                            <option value="Kiribati">Kiribati</option>
                            <option value="Korea, Democratic People's Republic of">Korea,
                                Democratic
                                People's Republic of</option>
                            <option value="Korea, Republic of">Korea, Republic of</option>
                            <option value="Kuwait">Kuwait</option>
                            <option value="Kyrgyzstan">Kyrgyzstan</option>
                            <option value="Lao People's Democratic Republic">Lao People's
                                Democratic
                                Republic</option>
                            <option value="Latvia">Latvia</option>
                            <option value="Lebanon">Lebanon</option>
                            <option value="Lesotho">Lesotho</option>
                            <option value="Liberia">Liberia</option>
                            <option value="Libyan Arab Jamahiriya">Libyan Arab Jamahiriya
                            </option>
                            <option value="Liechtenstein">Liechtenstein</option>
                            <option value="Lithuania">Lithuania</option>
                            <option value="Luxembourg">Luxembourg</option>
                            <option value="Macao">Macao</option>
                            <option value="Macedonia, The Former Yugoslav Republic of">
                                Macedonia, The Former
                                Yugoslav Republic of</option>
                            <option value="Madagascar">Madagascar</option>
                            <option value="Malawi">Malawi</option>
                            <option value="Malaysia">Malaysia</option>
                            <option value="Maldives">Maldives</option>
                            <option value="Mali">Mali</option>
                            <option value="Malta">Malta</option>
                            <option value="Marshall Islands">Marshall Islands</option>
                            <option value="Martinique">Martinique</option>
                            <option value="Mauritania">Mauritania</option>
                            <option value="Mauritius">Mauritius</option>
                            <option value="Mayotte">Mayotte</option>
                            <option value="Mexico">Mexico</option>
                            <option value="Micronesia, Federated States of">Micronesia,
                                Federated States of
                            </option>
                            <option value="Moldova, Republic of">Moldova, Republic of</option>
                            <option value="Monaco">Monaco</option>
                            <option value="Mongolia">Mongolia</option>
                            <option value="Montenegro">Montenegro</option>
                            <option value="Montserrat">Montserrat</option>
                            <option value="Morocco">Morocco</option>
                            <option value="Mozambique">Mozambique</option>
                            <option value="Myanmar">Myanmar</option>
                            <option value="Namibia">Namibia</option>
                            <option value="Nauru">Nauru</option>
                            <option value="Nepal">Nepal</option>
                            <option value="Netherlands">Netherlands</option>
                            <option value="Netherlands Antilles">Netherlands Antilles</option>
                            <option value="New Caledonia">New Caledonia</option>
                            <option value="New Zealand">New Zealand</option>
                            <option value="Nicaragua">Nicaragua</option>
                            <option value="Niger">Niger</option>
                            <option value="Nigeria">Nigeria</option>
                            <option value="Niue">Niue</option>
                            <option value="Norfolk Island">Norfolk Island</option>
                            <option value="Northern Mariana Islands">Northern Mariana Islands
                            </option>
                            <option value="Norway">Norway</option>
                            <option value="Oman">Oman</option>
                            <option value="Pakistan">Pakistan</option>
                            <option value="Palau">Palau</option>
                            <option value="Palestinian Territory, Occupied">Palestinian
                                Territory, Occupied
                            </option>
                            <option value="Panama">Panama</option>
                            <option value="Papua New Guinea">Papua New Guinea</option>
                            <option value="Paraguay">Paraguay</option>
                            <option value="Peru">Peru</option>
                            <option value="Philippines">Philippines</option>
                            <option value="Pitcairn">Pitcairn</option>
                            <option value="Poland">Poland</option>
                            <option value="Portugal">Portugal</option>
                            <option value="Puerto Rico">Puerto Rico</option>
                            <option value="Qatar">Qatar</option>
                            <option value="Reunion">Reunion</option>
                            <option value="Romania">Romania</option>
                            <option value="Russian Federation">Russian Federation</option>
                            <option value="Rwanda">Rwanda</option>
                            <option value="Saint Helena">Saint Helena</option>
                            <option value="Saint Kitts and Nevis">Saint Kitts and Nevis</option>
                            <option value="Saint Lucia">Saint Lucia</option>
                            <option value="Saint Pierre and Miquelon">Saint Pierre and Miquelon
                            </option>
                            <option value="Saint Vincent and The Grenadines">Saint Vincent and
                                The
                                Grenadines</option>
                            <option value="Samoa">Samoa</option>
                            <option value="San Marino">San Marino</option>
                            <option value="Sao Tome and Principe">Sao Tome and Principe</option>
                            <option value="Saudi Arabia">Saudi Arabia</option>
                            <option value="Senegal">Senegal</option>
                            <option value="Serbia">Serbia</option>
                            <option value="Seychelles">Seychelles</option>
                            <option value="Sierra Leone">Sierra Leone</option>
                            <option value="Singapore">Singapore</option>
                            <option value="Slovakia">Slovakia</option>
                            <option value="Slovenia">Slovenia</option>
                            <option value="Solomon Islands">Solomon Islands</option>
                            <option value="Somalia">Somalia</option>
                            <option value="South Africa">South Africa</option>
                            <option value="South Georgia and The South Sandwich Islands">South
                                Georgia and
                                The South Sandwich Islands</option>
                            <option value="Spain">Spain</option>
                            <option value="Sri Lanka">Sri Lanka</option>
                            <option value="Sudan">Sudan</option>
                            <option value="Suriname">Suriname</option>
                            <option value="Svalbard and Jan Mayen">Svalbard and Jan Mayen
                            </option>
                            <option value="Swaziland">Swaziland</option>
                            <option value="Sweden">Sweden</option>
                            <option value="Switzerland">Switzerland</option>
                            <option value="Syrian Arab Republic">Syrian Arab Republic</option>
                            <option value="Taiwan">Taiwan</option>
                            <option value="Tajikistan">Tajikistan</option>
                            <option value="Tanzania, United Republic of">Tanzania, United
                                Republic of
                            </option>
                            <option value="Thailand">Thailand</option>
                            <option value="Timor-leste">Timor-leste</option>
                            <option value="Togo">Togo</option>
                            <option value="Tokelau">Tokelau</option>
                            <option value="Tonga">Tonga</option>
                            <option value="Trinidad and Tobago">Trinidad and Tobago</option>
                            <option value="Tunisia">Tunisia</option>
                            <option value="Turkey">Turkey</option>
                            <option value="Turkmenistan">Turkmenistan</option>
                            <option value="Turks and Caicos Islands">Turks and Caicos Islands
                            </option>
                            <option value="Tuvalu">Tuvalu</option>
                            <option value="Uganda">Uganda</option>
                            <option value="Ukraine">Ukraine</option>
                            <option value="United Arab Emirates">United Arab Emirates</option>
                            <option value="United Kingdom">United Kingdom</option>
                            <option value="United States">United States</option>
                            <option value="United States Minor Outlying Islands">United States
                                Minor
                                Outlying Islands</option>
                            <option value="Uruguay">Uruguay</option>
                            <option value="Uzbekistan">Uzbekistan</option>
                            <option value="Vanuatu">Vanuatu</option>
                            <option value="Venezuela">Venezuela</option>
                            <option value="Viet Nam">Viet Nam</option>
                            <option value="Virgin Islands, British">Virgin Islands, British
                            </option>
                            <option value="Virgin Islands, U.S.">Virgin Islands, U.S.</option>
                            <option value="Wallis and Futuna">Wallis and Futuna</option>
                            <option value="Western Sahara">Western Sahara</option>
                            <option value="Yemen">Yemen</option>
                            <option value="Zambia">Zambia</option>
                            <option value="Zimbabwe">Zimbabwe</option>
                        </select>
                    </div>
                </div>
                <div class="col-md-4 mb-1">
                    <label for="passport_number" class="control-label">Passport Number<span
                                class="text-danger">*</span></label>
                    <input required type="text" name="passport_number" id="passport_number"
                           class="form-control" placeholder="Passport Number">
                </div>
            </div>

            <div class="row form-group">
                <div class="col-md-6">
                    <label for="email" class="control-label d-block">Email<span
                                class="text-danger">*</span></label>
                    <input required type="email" name="email" id="email" class="form-control"
                           placeholder="abc@domain.com">
                </div>
                <div class="col-md-6">
                    <label class="control-label d-block" for="phone_number">Phone Number<span
                                class="text-danger">*</span></label>

                    <input required type="text" name="phone_number" id="phone_number" class="form-control" value=""
                               placeholder="+44 (0) 7121348983">

                </div>
            </div>

            <div class="row form-group">
                <div class="col-md-6">
                    <div class="bg-light p-4 pb-0 rounded" style="padding-bottom:4px !important">
                        <div class="form-group">
                            <label for="address" class="control-label  d-block">Address
                                <span class="text-danger">*</span></label>
                            <input required type="text" name="address1" id="address1" class="form-control mb-3"
                                   placeholder="Street Address">
                            <input type="text" id="address2" name="address2" class="form-control mb-3"
                                   placeholder="Street Address 2">
                            <div class="row">
                                <div class="col-lg-6">
                                    <input required type="text" id="city" name="city" class="form-control mb-3"
                                           placeholder="City">
                                </div>
                                <div class="col-lg-6">
                                    <input required type="text" id="state" name="state" class="form-control mb-3"
                                           placeholder="State / Province">
                                </div>
                                <div class="col-lg-6">
                                    <input type="text" id="zip_code" name="zip_code" class="form-control mb-3"
                                           placeholder="Postal Code / Zip Code">
                                </div>
                                <div class="col-lg-6">
                                    <select required name="country" id="country" class="form-control">
                                        <option value="" selected="" disabled="">Country</option>
                                        <option value="Afghanistan">Afghanistan</option>
                                        <option value="Åland Islands">Åland Islands</option>
                                        <option value="Albania">Albania</option>
                                        <option value="Algeria">Algeria</option>
                                        <option value="American Samoa">American Samoa</option>
                                        <option value="Andorra">Andorra</option>
                                        <option value="Angola">Angola</option>
                                        <option value="Anguilla">Anguilla</option>
                                        <option value="Antarctica">Antarctica</option>
                                        <option value="Antigua and Barbuda">Antigua and Barbuda</option>
                                        <option value="Argentina">Argentina</option>
                                        <option value="Armenia">Armenia</option>
                                        <option value="Aruba">Aruba</option>
                                        <option value="Australia">Australia</option>
                                        <option value="Austria">Austria</option>
                                        <option value="Azerbaijan">Azerbaijan</option>
                                        <option value="Bahamas">Bahamas</option>
                                        <option value="Bahrain">Bahrain</option>
                                        <option value="Bangladesh">Bangladesh</option>
                                        <option value="Barbados">Barbados</option>
                                        <option value="Belarus">Belarus</option>
                                        <option value="Belgium">Belgium</option>
                                        <option value="Belize">Belize</option>
                                        <option value="Benin">Benin</option>
                                        <option value="Bermuda">Bermuda</option>
                                        <option value="Bhutan">Bhutan</option>
                                        <option value="Bolivia">Bolivia</option>
                                        <option value="Bosnia and Herzegovina">Bosnia and Herzegovina
                                        </option>
                                        <option value="Botswana">Botswana</option>
                                        <option value="Bouvet Island">Bouvet Island</option>
                                        <option value="Brazil">Brazil</option>
                                        <option value="British Indian Ocean Territory">British Indian
                                            OceanTerritory</option>
                                        <option value="Brunei Darussalam">Brunei Darussalam</option>
                                        <option value="Bulgaria">Bulgaria</option>
                                        <option value="Burkina Faso">Burkina Faso</option>
                                        <option value="Burundi">Burundi</option>
                                        <option value="Cambodia">Cambodia</option>
                                        <option value="Cameroon">Cameroon</option>
                                        <option value="Canada">Canada</option>
                                        <option value="Cape Verde">Cape Verde</option>
                                        <option value="Cayman Islands">Cayman Islands</option>
                                        <option value="Central African Republic">Central African Republic
                                        </option>
                                        <option value="Chad">Chad</option>
                                        <option value="Chile">Chile</option>
                                        <option value="China">China</option>
                                        <option value="Christmas Island">Christmas Island</option>
                                        <option value="Cocos (Keeling) Islands">Cocos (Keeling) Islands
                                        </option>
                                        <option value="Colombia">Colombia</option>
                                        <option value="Comoros">Comoros</option>
                                        <option value="Congo">Congo</option>
                                        <option value="Congo, The Democratic Republic of The">Congo, The
                                            Democratic Republic of The</option>
                                        <option value="Cook Islands">Cook Islands</option>
                                        <option value="Costa Rica">Costa Rica</option>
                                        <option value="Cote D'ivoire">Cote D'ivoire</option>
                                        <option value="Croatia">Croatia</option>
                                        <option value="Cuba">Cuba</option>
                                        <option value="Cyprus">Cyprus</option>
                                        <option value="Czech Republic">Czech Republic</option>
                                        <option value="Denmark">Denmark</option>
                                        <option value="Djibouti">Djibouti</option>
                                        <option value="Dominica">Dominica</option>
                                        <option value="Dominican Republic">Dominican Republic</option>
                                        <option value="Ecuador">Ecuador</option>
                                        <option value="Egypt">Egypt</option>
                                        <option value="El Salvador">El Salvador</option>
                                        <option value="Equatorial Guinea">Equatorial Guinea</option>
                                        <option value="Eritrea">Eritrea</option>
                                        <option value="Estonia">Estonia</option>
                                        <option value="Ethiopia">Ethiopia</option>
                                        <option value="Falkland Islands (Malvinas)">Falkland
                                            Islands(Malvinas)</option>
                                        <option value="Faroe Islands">Faroe Islands</option>
                                        <option value="Fiji">Fiji</option>
                                        <option value="Finland">Finland</option>
                                        <option value="France">France</option>
                                        <option value="French Guiana">French Guiana</option>
                                        <option value="French Polynesia">French Polynesia</option>
                                        <option value="French Southern Territories">French Southern
                                            Territories</option>
                                        <option value="Gabon">Gabon</option>
                                        <option value="Gambia">Gambia</option>
                                        <option value="Georgia">Georgia</option>
                                        <option value="Germany">Germany</option>
                                        <option value="Ghana">Ghana</option>
                                        <option value="Gibraltar">Gibraltar</option>
                                        <option value="Greece">Greece</option>
                                        <option value="Greenland">Greenland</option>
                                        <option value="Grenada">Grenada</option>
                                        <option value="Guadeloupe">Guadeloupe</option>
                                        <option value="Guam">Guam</option>
                                        <option value="Guatemala">Guatemala</option>
                                        <option value="Guernsey">Guernsey</option>
                                        <option value="Guinea">Guinea</option>
                                        <option value="Guinea-bissau">Guinea-bissau</option>
                                        <option value="Guyana">Guyana</option>
                                        <option value="Haiti">Haiti</option>
                                        <option value="Heard Island and Mcdonald Islands">Heard Island and
                                            Mcdonald Islands</option>
                                        <option value="Holy See (Vatican City State)">Holy See (Vatican
                                            CityState)</option>
                                        <option value="Honduras">Honduras</option>
                                        <option value="Hong Kong">Hong Kong</option>
                                        <option value="Hungary">Hungary</option>
                                        <option value="Iceland">Iceland</option>
                                        <option value="India">India</option>
                                        <option value="Indonesia">Indonesia</option>
                                        <option value="Iran, Islamic Republic of">Iran, Islamic Republic of
                                        </option>
                                        <option value="Iraq">Iraq</option>
                                        <option value="Ireland">Ireland</option>
                                        <option value="Isle of Man">Isle of Man</option>
                                        <option value="Israel">Israel</option>
                                        <option value="Italy">Italy</option>
                                        <option value="Jamaica">Jamaica</option>
                                        <option value="Japan">Japan</option>
                                        <option value="Jersey">Jersey</option>
                                        <option value="Jordan">Jordan</option>
                                        <option value="Kazakhstan">Kazakhstan</option>
                                        <option value="Kenya">Kenya</option>
                                        <option value="Kiribati">Kiribati</option>
                                        <option value="Korea, Democratic People's Republic of">Korea,
                                            Democratic People's Republic of</option>
                                        <option value="Korea, Republic of">Korea, Republic of</option>
                                        <option value="Kuwait">Kuwait</option>
                                        <option value="Kyrgyzstan">Kyrgyzstan</option>
                                        <option value="Lao People's Democratic Republic">Lao People's
                                            Democratic Republic</option>
                                        <option value="Latvia">Latvia</option>
                                        <option value="Lebanon">Lebanon</option>
                                        <option value="Lesotho">Lesotho</option>
                                        <option value="Liberia">Liberia</option>
                                        <option value="Libyan Arab Jamahiriya">Libyan Arab Jamahiriya
                                        </option>
                                        <option value="Liechtenstein">Liechtenstein</option>
                                        <option value="Lithuania">Lithuania</option>
                                        <option value="Luxembourg">Luxembourg</option>
                                        <option value="Macao">Macao</option>
                                        <option value="Macedonia, The Former Yugoslav Republic of">
                                            Macedonia, The Former Yugoslav Republic of</option>
                                        <option value="Madagascar">Madagascar</option>
                                        <option value="Malawi">Malawi</option>
                                        <option value="Malaysia">Malaysia</option>
                                        <option value="Maldives">Maldives</option>
                                        <option value="Mali">Mali</option>
                                        <option value="Malta">Malta</option>
                                        <option value="Marshall Islands">Marshall Islands</option>
                                        <option value="Martinique">Martinique</option>
                                        <option value="Mauritania">Mauritania</option>
                                        <option value="Mauritius">Mauritius</option>
                                        <option value="Mayotte">Mayotte</option>
                                        <option value="Mexico">Mexico</option>
                                        <option value="Micronesia, Federated States of">Micronesia,
                                            Federated States of</option>
                                        <option value="Moldova, Republic of">Moldova, Republic of</option>
                                        <option value="Monaco">Monaco</option>
                                        <option value="Mongolia">Mongolia</option>
                                        <option value="Montenegro">Montenegro</option>
                                        <option value="Montserrat">Montserrat</option>
                                        <option value="Morocco">Morocco</option>
                                        <option value="Mozambique">Mozambique</option>
                                        <option value="Myanmar">Myanmar</option>
                                        <option value="Namibia">Namibia</option>
                                        <option value="Nauru">Nauru</option>
                                        <option value="Nepal">Nepal</option>
                                        <option value="Netherlands">Netherlands</option>
                                        <option value="Netherlands Antilles">Netherlands Antilles</option>
                                        <option value="New Caledonia">New Caledonia</option>
                                        <option value="New Zealand">New Zealand</option>
                                        <option value="Nicaragua">Nicaragua</option>
                                        <option value="Niger">Niger</option>
                                        <option value="Nigeria">Nigeria</option>
                                        <option value="Niue">Niue</option>
                                        <option value="Norfolk Island">Norfolk Island</option>
                                        <option value="Northern Mariana Islands">Northern Mariana Islands
                                        </option>
                                        <option value="Norway">Norway</option>
                                        <option value="Oman">Oman</option>
                                        <option value="Pakistan">Pakistan</option>
                                        <option value="Palau">Palau</option>
                                        <option value="Palestinian Territory, Occupied">Palestinian
                                            Territory, Occupied</option>
                                        <option value="Panama">Panama</option>
                                        <option value="Papua New Guinea">Papua New Guinea</option>
                                        <option value="Paraguay">Paraguay</option>
                                        <option value="Peru">Peru</option>
                                        <option value="Philippines">Philippines</option>
                                        <option value="Pitcairn">Pitcairn</option>
                                        <option value="Poland">Poland</option>
                                        <option value="Portugal">Portugal</option>
                                        <option value="Puerto Rico">Puerto Rico</option>
                                        <option value="Qatar">Qatar</option>
                                        <option value="Reunion">Reunion</option>
                                        <option value="Romania">Romania</option>
                                        <option value="Russian Federation">Russian Federation</option>
                                        <option value="Rwanda">Rwanda</option>
                                        <option value="Saint Helena">Saint Helena</option>
                                        <option value="Saint Kitts and Nevis">Saint Kitts and Nevis</option>
                                        <option value="Saint Lucia">Saint Lucia</option>
                                        <option value="Saint Pierre and Miquelon">Saint Pierre and Miquelon
                                        </option>
                                        <option value="Saint Vincent and The Grenadines">Saint Vincent and
                                            The Grenadines</option>
                                        <option value="Samoa">Samoa</option>
                                        <option value="San Marino">San Marino</option>
                                        <option value="Sao Tome and Principe">Sao Tome and Principe</option>
                                        <option value="Saudi Arabia">Saudi Arabia</option>
                                        <option value="Senegal">Senegal</option>
                                        <option value="Serbia">Serbia</option>
                                        <option value="Seychelles">Seychelles</option>
                                        <option value="Sierra Leone">Sierra Leone</option>
                                        <option value="Singapore">Singapore</option>
                                        <option value="Slovakia">Slovakia</option>
                                        <option value="Slovenia">Slovenia</option>
                                        <option value="Solomon Islands">Solomon Islands</option>
                                        <option value="Somalia">Somalia</option>
                                        <option value="South Africa">South Africa</option>
                                        <option value="South Georgia and The South Sandwich Islands">South
                                            Georgia and The South Sandwich Islands</option>
                                        <option value="Spain">Spain</option>
                                        <option value="Sri Lanka">Sri Lanka</option>
                                        <option value="Sudan">Sudan</option>
                                        <option value="Suriname">Suriname</option>
                                        <option value="Svalbard and Jan Mayen">Svalbard and Jan Mayen
                                        </option>
                                        <option value="Swaziland">Swaziland</option>
                                        <option value="Sweden">Sweden</option>
                                        <option value="Switzerland">Switzerland</option>
                                        <option value="Syrian Arab Republic">Syrian Arab Republic</option>
                                        <option value="Taiwan">Taiwan</option>
                                        <option value="Tajikistan">Tajikistan</option>
                                        <option value="Tanzania, United Republic of">Tanzania, United
                                            Republic of</option>
                                        <option value="Thailand">Thailand</option>
                                        <option value="Timor-leste">Timor-leste</option>
                                        <option value="Togo">Togo</option>
                                        <option value="Tokelau">Tokelau</option>
                                        <option value="Tonga">Tonga</option>
                                        <option value="Trinidad and Tobago">Trinidad and Tobago</option>
                                        <option value="Tunisia">Tunisia</option>
                                        <option value="Turkey">Turkey</option>
                                        <option value="Turkmenistan">Turkmenistan</option>
                                        <option value="Turks and Caicos Islands">Turks and Caicos Islands
                                        </option>
                                        <option value="Tuvalu">Tuvalu</option>
                                        <option value="Uganda">Uganda</option>
                                        <option value="Ukraine">Ukraine</option>
                                        <option value="United Arab Emirates">United Arab Emirates</option>
                                        <option value="United Kingdom">United Kingdom</option>
                                        <option value="United States">United States</option>
                                        <option value="United States Minor Outlying Islands">United States
                                            Minor Outlying Islands</option>
                                        <option value="Uruguay">Uruguay</option>
                                        <option value="Uzbekistan">Uzbekistan</option>
                                        <option value="Vanuatu">Vanuatu</option>
                                        <option value="Venezuela">Venezuela</option>
                                        <option value="Viet Nam">Viet Nam</option>
                                        <option value="Virgin Islands, British">Virgin Islands, British
                                        </option>
                                        <option value="Virgin Islands, U.S.">Virgin Islands, U.S.</option>
                                        <option value="Wallis and Futuna">Wallis and Futuna</option>
                                        <option value="Western Sahara">Western Sahara</option>
                                        <option value="Yemen">Yemen</option>
                                        <option value="Zambia">Zambia</option>
                                        <option value="Zimbabwe">Zimbabwe</option>
                                    </select>
                                </div>
                            </div>
                        </div>
                    </div>
                </div>
                <div class="col-md-6">
                    <div class="p-4 pb-0 rounded emergency-box-style">
                        <div class="form-group">
                            <label for="present_address" class="control-label  d-block">Emergency Contact
                                <span class="text-danger">*</span></label>
                            <input required type="text" id="emergency_contact_name" name="emergency_contact_name"
                                   class="form-control mb-3" placeholder="Name">
                            <input required type="text" id="emergency_contact_relation" name="emergency_contact_relation"
                                   class="form-control mb-3" placeholder="Relation">
                            <div class="row">
                                <div class="col-lg-12">
                                    <input required type="email" name="emergency_contact_email"
                                           id="emergency_contact_email" class="form-control mb-3"
                                           placeholder="abc@domain.com (Email)">
                                </div>
                                <div class="col-lg-12">
                                    <input required type="text" id="emergency_contact_phone_number" name="emergency_contact_phone_number"
                                           class="form-control mb-3" value=""
                                           placeholder="+44 (0) 7121348983 (Phone Number)">
                                </div>

                            </div>
                        </div>
                    </div>

                </div>
            </div>

            <div class="row form-group">
                <div class="col-lg-12 mb-3">
                    <label class="control-label" for="speak_language">What language do you speak?<span
                                class="text-danger">*</span></label>
                    <input required type="text" class="form-control" name="speak_language" id="speak_language" maxlength="10" value=""
                           placeholder="Language">
                </div>
            </div>

            <div class="col-12 ">
                <h4 class="text-center rounded text-white fw-bold pt-1 pb-1 hd-line-height"
                    style="background:#ccc">
                    <b>Educational record to date (list your top 3 qualifications)</b>
                </h4>
            </div>

            <div class="row">

                <div class="col-md-4 mb-1">
                    <label for="education_name1" class="control-label">Education<span
                                class="text-danger">*</span></label>
                    <input required type="text" name="education_name1" id="education_name1"
                           class="form-control" placeholder="Education">
                </div>
                <div class="col-md-2 mb-1">
                    <label for="education_year1" class="control-label">Year<span
                                class="text-danger">*</span></label>
                    <select required name="education_year1" id="education_year1"
                            class="form-control">
                        <option disabled="" selected="" value="">Year</option>
                        <option value="1970">1970</option>
                        <option value="1971">1971</option>
                        <option value="1972">1972</option>
                        <option value="1973">1973</option>
                        <option value="1974">1974</option>
                        <option value="1975">1975</option>
                        <option value="1976">1976</option>
                        <option value="1977">1977</option>
                        <option value="1978">1978</option>
                        <option value="1979">1979</option>
                        <option value="1980">1980</option>
                        <option value="1981">1981</option>
                        <option value="1982">1982</option>
                        <option value="1983">1983</option>
                        <option value="1984">1984</option>
                        <option value="1985">1985</option>
                        <option value="1986">1986</option>
                        <option value="1987">1987</option>
                        <option value="1988">1988</option>
                        <option value="1989">1989</option>
                        <option value="1990">1990</option>
                        <option value="1991">1991</option>
                        <option value="1992">1992</option>
                        <option value="1993">1993</option>
                        <option value="1994">1994</option>
                        <option value="1995">1995</option>
                        <option value="1996">1996</option>
                        <option value="1997">1997</option>
                        <option value="1998">1998</option>
                        <option value="1999">1999</option>
                        <option value="2000">2000</option>
                        <option value="2001">2001</option>
                        <option value="2002">2002</option>
                        <option value="2003">2003</option>
                        <option value="2004">2004</option>
                        <option value="2005">2005</option>
                        <option value="2006">2006</option>
                        <option value="2007">2007</option>
                        <option value="2008">2008</option>
                        <option value="2009">2009</option>
                        <option value="2010">2010</option>
                        <option value="2011">2011</option>
                        <option value="2012">2012</option>
                        <option value="2013">2013</option>
                        <option value="2014">2014</option>
                        <option value="2015">2015</option>
                        <option value="2016">2016</option>
                        <option value="2017">2017</option>
                        <option value="2018">2018</option>
                        <option value="2019">2019</option>
                        <option value="2020">2020</option>
                        <option value="2021">2021</option>
                        <option value="2022">2022</option>
                        <option value="2023">2023</option>
                        <option value="2024">2024</option>
                        <option value="2025">2025</option>
                        <option value="2026">2026</option>
                        <option value="2027">2027</option>
                        <option value="2028">2028</option>
                        <option value="2029">2029</option>
                        <option value="2030">2030</option>

                    </select>
                </div>
                <div class="col-md-5 mb-1">
                    <label for="education_institution1" class="control-label">School / College<span
                                class="text-danger">*</span></label>
                    <input required type="text" name="education_institution1" id="education_institution1"
                           class="form-control" placeholder="School / College">
                </div>
            </div>
            <div class="row">
                <div class="col-md-4 mb-1">
                    <label for="education_name2" class="control-label"></label>
                    <input type="text" name="education_name2" id="education_name2" class="form-control"
                           placeholder="Education">
                </div>
                <div class="col-md-2 mb-1">
                    <label for="education_year2" class="control-label"></label>
                    <select name="education_year2" id="education_year2" class="form-control">
                        <option disabled="" selected="" value="">Year</option>
                        <option value="1970">1970</option>
                        <option value="1971">1971</option>
                        <option value="1972">1972</option>
                        <option value="1973">1973</option>
                        <option value="1974">1974</option>
                        <option value="1975">1975</option>
                        <option value="1976">1976</option>
                        <option value="1977">1977</option>
                        <option value="1978">1978</option>
                        <option value="1979">1979</option>
                        <option value="1980">1980</option>
                        <option value="1981">1981</option>
                        <option value="1982">1982</option>
                        <option value="1983">1983</option>
                        <option value="1984">1984</option>
                        <option value="1985">1985</option>
                        <option value="1986">1986</option>
                        <option value="1987">1987</option>
                        <option value="1988">1988</option>
                        <option value="1989">1989</option>
                        <option value="1990">1990</option>
                        <option value="1991">1991</option>
                        <option value="1992">1992</option>
                        <option value="1993">1993</option>
                        <option value="1994">1994</option>
                        <option value="1995">1995</option>
                        <option value="1996">1996</option>
                        <option value="1997">1997</option>
                        <option value="1998">1998</option>
                        <option value="1999">1999</option>
                        <option value="2000">2000</option>
                        <option value="2001">2001</option>
                        <option value="2002">2002</option>
                        <option value="2003">2003</option>
                        <option value="2004">2004</option>
                        <option value="2005">2005</option>
                        <option value="2006">2006</option>
                        <option value="2007">2007</option>
                        <option value="2008">2008</option>
                        <option value="2009">2009</option>
                        <option value="2010">2010</option>
                        <option value="2011">2011</option>
                        <option value="2012">2012</option>
                        <option value="2013">2013</option>
                        <option value="2014">2014</option>
                        <option value="2015">2015</option>
                        <option value="2016">2016</option>
                        <option value="2017">2017</option>
                        <option value="2018">2018</option>
                        <option value="2019">2019</option>
                        <option value="2020">2020</option>
                        <option value="2021">2021</option>
                        <option value="2022">2022</option>
                        <option value="2023">2023</option>
                        <option value="2024">2024</option>
                        <option value="2025">2025</option>
                        <option value="2026">2026</option>
                        <option value="2027">2027</option>
                        <option value="2028">2028</option>
                        <option value="2029">2029</option>
                        <option value="2030">2030</option>

                    </select>
                </div>
                <div class="col-md-5 mb-1">
                    <label for="education_institution2" class="control-label"></label>
                    <input type="text" name="education_institution2" id="education_institution2"
                           class="form-control" placeholder="School / College">
                </div>
            </div>
            <div class="row">

                <div class="col-md-4 mb-1">
                    <label for="education_name3" class="control-label"></label>
                    <input type="text" name="education_name3" id="education_name3" class="form-control"
                           placeholder="Education">
                </div>
                <div class="col-md-2 mb-1">
                    <label for="education_year3" class="control-label"></label>
                    <select name="education_year3" id="education_year3" class="form-control">
                        <option disabled="" selected="" value="">Year</option>
                        <option value="1970">1970</option>
                        <option value="1971">1971</option>
                        <option value="1972">1972</option>
                        <option value="1973">1973</option>
                        <option value="1974">1974</option>
                        <option value="1975">1975</option>
                        <option value="1976">1976</option>
                        <option value="1977">1977</option>
                        <option value="1978">1978</option>
                        <option value="1979">1979</option>
                        <option value="1980">1980</option>
                        <option value="1981">1981</option>
                        <option value="1982">1982</option>
                        <option value="1983">1983</option>
                        <option value="1984">1984</option>
                        <option value="1985">1985</option>
                        <option value="1986">1986</option>
                        <option value="1987">1987</option>
                        <option value="1988">1988</option>
                        <option value="1989">1989</option>
                        <option value="1990">1990</option>
                        <option value="1991">1991</option>
                        <option value="1992">1992</option>
                        <option value="1993">1993</option>
                        <option value="1994">1994</option>
                        <option value="1995">1995</option>
                        <option value="1996">1996</option>
                        <option value="1997">1997</option>
                        <option value="1998">1998</option>
                        <option value="1999">1999</option>
                        <option value="2000">2000</option>
                        <option value="2001">2001</option>
                        <option value="2002">2002</option>
                        <option value="2003">2003</option>
                        <option value="2004">2004</option>
                        <option value="2005">2005</option>
                        <option value="2006">2006</option>
                        <option value="2007">2007</option>
                        <option value="2008">2008</option>
                        <option value="2009">2009</option>
                        <option value="2010">2010</option>
                        <option value="2011">2011</option>
                        <option value="2012">2012</option>
                        <option value="2013">2013</option>
                        <option value="2014">2014</option>
                        <option value="2015">2015</option>
                        <option value="2016">2016</option>
                        <option value="2017">2017</option>
                        <option value="2018">2018</option>
                        <option value="2019">2019</option>
                        <option value="2020">2020</option>
                        <option value="2021">2021</option>
                        <option value="2022">2022</option>
                        <option value="2023">2023</option>
                        <option value="2024">2024</option>
                        <option value="2025">2025</option>
                        <option value="2026">2026</option>
                        <option value="2027">2027</option>
                        <option value="2028">2028</option>
                        <option value="2029">2029</option>
                        <option value="2030">2030</option>

                    </select>
                </div>
                <div class="col-md-5 mb-1">
                    <label for="education3_school" class="control-label"></label>
                    <input type="text" name="education_institution3" id="education_institution3"
                           class="form-control" placeholder="School / College">
                </div>
            </div>
            <div class="col-12 ">
                <h4 class="text-center rounded text-white fw-bold pt-1 pb-1 hd-line-height"
                    style="background:#ccc">
                    <b>Employment details (Most recent employer)</b>
                </h4>
            </div>
            <div class="row form-group">
                <div class="col-md-6">
                    <label for="employer_name" class="control-label d-block">Name of Employer</label>
                    <input type="text" name="employer_name" id="employer_name" class="form-control"
                           placeholder="Name of Employer">
                </div>
                <div class="col-md-6">
                    <label class="control-label d-block" for="position">Position</label>

                    <input type="text" id="position" name="position" class="form-control"
                               placeholder="Position">

                </div>
            </div>
            <div class="row form-group">

                <div class="col-lg-9 center-block">
                    <?= $this->Form->button(__('Submit'), ['class' => 'btn btn-success tab3Save pull-left btn-grid btn-flat','id'=>'submit']) ?>
                    <a href="<?php echo $this->Url->build('/feed-back'); ?>"  class="btn btn-default tab3Save pull-left btn-grid btn-flat btn-orange-color" id="default-btn">
                        <?php echo __('Back'); ?>
                    </a>
                </div>
            </div>
          <!-- /.row -->
        </div>
        <!-- /.box-body -->
            <?= $this->Form->end() ?>
      </div>
      
<style type="text/css">

    .error-message {
        color: #ff0000;
    }


</style>


