html-forms/form3.html at master · chelseadeonne/html-forms · GitHub

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<!DOCTYPE html>
<html lang="en">

    <head>
        <link type="text/css" rel="stylesheet" href="style.css">
        <title>Contact Form 3</title>
    </head>
    <body>
    <div id="form3-container">
       	<div class="form3-title"><h4>Instructions for Application - Academic Year 2014</h4></div>
    	<ol class="form3-outline">
    			<li>The deadline for 2015-2016 scholarship application: March 30, 2015. Applications received after March 30 will be considered on a funds available basis.</li>
    			<li>Only completed applications will be considered. Do Not Leave Items Blank.</li>
    			<li>Attach a current copy of your high school and/or college transcripts.</li>
    			<li>Two signed letters of recommendation (from non-relatives) must be attached to this application.</li>
    	</ol>
    	<p class="form3-p">Consideration for any scholarship award is based on a point system including GPA, participation in extra-curricular activities, school organizations and community service. This will be a four semester scholarship, and you must maintain criteria set in the guidelines.</p>
    	<h4 class="form3-h4">Application Data</h4>
    	<form>
    		<input class="form3-input-left"type="text" name="last,first, mi" placeholder="Last Name, First Name, MI">
    		<input id="form3-input-social"type="text" name="ssi" placeholder="Social Security #"><br>
	    	<input class="form3-input-left"type="text" name="address" placeholder="City, State, Zip, County">
	    	<input class="form3-input-right"type="text" name="phone" placeholder="Permanent Home Phone"><br>
	    	<input class="form3-input-left"type="text" name="major" placeholder="Intended major at University">
	    	<input class="form3-input-right"type="text" name="location" placeholder="At which location will you be"><br>
            <input class="form3-button" type="submit" value="Next &raquo">

	    </form>
    </div>
    </body>

</html>