{{$pop_up_title}}

{!! Form::open(['url' =>secure_url('college/new-registration'),'method'=>'POST','name'=>'collegeRegister','id'=>'js_college_register']) !!} {!! Form::hidden('request_type',$request_type) !!}
{!! Form::select("university", array(),'',array("class"=>"form-control select8", "id"=>"js-university", "data-live-search"=>"true",'tabindex'=>1)) !!} @if ($errors->has('university')) {!! $errors->first('university') !!} @endif
{!! Form::select("college",[""=>"Select college *"] + array(),null,array("class"=>"form-control select8", "data-live-search"=>"true","id"=>"js-college",'tabindex'=>2)) !!} @if ($errors->has('college')) {!! $errors->first('college') !!} @endif
{!! Form::email("email_address","",array("class"=>"form-control","placeholder"=>"Email address *","id"=>"js-email-address", 'tabindex'=>3)) !!} @if ($errors->has('email_address')) {!! $errors->first('email_address') !!} @endif
{!! Form::text("contact_number","",array("class"=>"form-control","placeholder"=>"Contact number *","id"=>"js-contact-number", "maxlength"=>"12",'tabindex'=>4)) !!} @if ($errors->has('contact_number')) {!! $errors->first('contact_number') !!} @endif
{!! Form::text("spoc_name","",array("class"=>"form-control","placeholder"=>"Contact person name *","id"=>"spoc_name",'tabindex'=>5)) !!} @if ($errors->has('spoc_name')) {!! $errors->first('spoc_name') !!} @endif
{!! Form::text("website_address","",array("class"=>"form-control","placeholder"=>"Website address *","id"=>"js-website-address", 'tabindex'=>6)) !!} @if ($errors->has('website_address')) {!! $errors->first('website_address') !!} @endif
{!! Form::password("password",array("class"=>"form-control","placeholder"=>"Password *","id"=>"js-college-password",'tabindex'=>7)) !!} @if ($errors->has('password')) {!! $errors->first('password') !!} @endif
{!! Form::password("confirm_password",array("class"=>"form-control","placeholder"=>"Confirm password *",'tabindex'=>8)) !!} @if ($errors->has('confirm_password')) {!! $errors->first('confirm_password') !!} @endif
{!! Form::text("address","",array("class"=>"form-control","placeholder"=>"Address *",'tabindex'=>9)) !!} @if ($errors->has('address')) {!! $errors->first('address') !!} @endif
{!! NoCaptcha::renderJs() !!} {!! NoCaptcha::display() !!}

Already Registered College! Login

{!! Form::close() !!}