|
Server IP : 172.16.15.8 / Your IP : 18.188.59.124 Web Server : Apache System : Linux zeus.vwu.edu 4.18.0-553.27.1.el8_10.x86_64 #1 SMP Wed Nov 6 14:29:02 UTC 2024 x86_64 User : apache ( 48) PHP Version : 7.2.24 Disable Function : NONE MySQL : OFF | cURL : ON | WGET : ON | Perl : ON | Python : ON Directory (0755) : /home/kahenry/www/ |
| [ Home ] | [ C0mmand ] | [ Upload File ] |
|---|
<!--
File: TestForm.php
Contains the action page for the Qualification Test and details to function for each entry.
-->
<?php session_start(); ?>
<?php
$pass = $_SESSION['pass'];
if($pass != "password") print "Go away.";
else
{
?>
<CENTER>
<H1>
Qualification Test
</H1>
<Font color=red size=5>
<BODY background="https://www.lung.org/getmedia/d2498cc8-ffc2-4250-a1cd-6fb6fa59b4d4/COVID19_Open-Graph.jpg?width=1200&height=630&ext=.jpg">
<HR>
<FORM action= ReviewTest.php method=post>
Name: <input type=text size=15 name=name> <p>
<HR>
Email: <input type=text size=15 name=email> <p>
<HR>
Phone Number: <input type=text size=15 name=number> <p>
<HR>
<u> Prefered Contact: </u>
<input type=radio name=Mail value=Email> Email <input type=radio name=Mail value=Phone> Phone
<HR>
<u> Gender: <BR> </u>
<input type=radio name=Gender value=Male> Male
<p>
<input type=radio name=Gender value=Female> Female
<p>
<input type=radio name=Gender value=Other> Other
<HR>
<p>
<u> Please Select a Symptom:<BR> </u>
<input type=radio name=Select value=Cough> Cough
<p>
<input type=radio name=Select value=Sneezing> Sneezing
<p>
<input type=radio name=Select value=Vomiting> Vomiting
<p>
<input type=radio name=Select value=None> None
<HR>
<input type=submit value=Submit>
<input type=reset value=Reset>
</FORM>
</BODY>
<A HREF=FinalProject.html> BACK </A>
</CENTER>
<?php
}
?>