97 lines
3.5 KiB
HTML
97 lines
3.5 KiB
HTML
## mako
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<%page expression_filter="h"/>
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<%!
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from django.utils.translation import ugettext as _
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from openedx.core.djangolib.markup import Text, HTML
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from datetime import datetime
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import pytz
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from django.conf import settings
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%>
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<%inherit file="../main.html" />
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<%namespace name='static' file='../static_content.html'/>
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<%block name="pagetitle">${_("Contact Us")}</%block>
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<div class="page-heading">
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<h1>${_("Contact Us")}</h1>
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</div>
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<section class="static-content">
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<div class="grid-manual grid-container">
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<div class="inner-container">
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<div class="row">
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<div class="col col-12 sm-col-10 md-col-8 lg-col-6 xl-col-6 col-centered">
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<form id="contact_form" class="form-block">
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<div class="input-group">
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<label for="">Email*</label>
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<input type="text" class="input-lg" id="email">
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</div>
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<div class="input-group">
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<label for="">Full Name*</label>
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<input type="text" class="input-lg" id="name">
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</div>
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<div class="input-group">
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<label for="">I am a</label>
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<div class="custom-select">
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<select name="user_type" id="user_type" class="input-lg">
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<option value="">Select</option>
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<option value="learner">Learner</option>
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<option value="teacher">Teacher</option>
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<option value="other">Other</option>
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</select>
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</div>
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</div>
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<div class="input-group">
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<label for="">Inquiry Type*</label>
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<div class="custom-select">
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<select id="subject" class="input-lg">
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<option value="">Select</option>
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<option value="payments">Payments</option>
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<option value="certificates">Certificates</option>
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<option value="assessments">Assessments</option>
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<option value="videos">Videos</option>
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<option value="discussion-forums">Discussion Forums</option>
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<option value="mobile-application">Mobile Application</option>
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</select>
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</div>
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</div>
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<div class="input-group">
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<label for="">Message*</label>
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<textarea id="details" rows="10"></textarea>
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</div>
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<input type="text" name="issue_type" id="issue_type" value="contact" class="hidden">
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<button class="btn-brand btn-client btn-lg" id="submit_btn">Submit</button>
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<div class="input-group">
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<label for="" class="text-light">* Required Fields</label>
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</div>
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</form>
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</div>
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</div>
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</div>
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</div>
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</section>
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<a href="#success-message" class="media hidden" id="success-message-btn" rel="leanModal">
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</a>
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<div id="success-message" class="modal">
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<div class="alert alert-success" role="alert" aria-labelledby="alert-title-success" tabindex="-1">
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<span class="icon alert-icon icon-check" aria-hidden="true">
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<i class="fa fa-check" aria-hidden="true"></i>
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</span>
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<div class="alert-message">
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<h3 class="alert-title" id="alert-title-success">
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${_("Thank you for your inquiry")}
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</h3>
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<p class="alert-copy-with-title">
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We'll get back to you within 24 hours.
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</p>
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</div>
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</div>
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</div>
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<%block name="js_extra">
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<script src="${static.url('js/contact-form.js')}"></script>
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</%block>
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