1+ < html >
2+ < head > < title > re-evaluation form</ title >
3+ < link rel ="stylesheet " type ="text/css " href ="style.css "> </ head >
4+ < body >
5+ < h2 > PES student re-evaluation form</ h2 >
6+ < img src ="logo.png " height ="40 " width ="100 px ">
7+ < form id ="form ">
8+ < table border ="2 " align ="center ">
9+ < tr >
10+ < td > Name:</ td >
11+ < td > < input type ="text " name ="name " required > </ td >
12+ </ tr >
13+ < tr >
14+ < td > SRN:</ td >
15+ < td > < input type ="text " name ="SRN " required > </ td >
16+ </ tr >
17+ < tr >
18+ < td > Gender:</ td >
19+ < td > < input type ="radio " name ="female " value ="female "> female
20+ < input type ="radio " name ="male " value ="male "> male</ td >
21+ </ tr >
22+ < tr >
23+ < td > Subject for re-evaluation:</ td >
24+ < td > < select name ="subject " required >
25+ < option value ="ddco "> DDCO</ option >
26+ < option value ="afll "> WEB TECH</ option >
27+ < option value ="afll "> AFLL</ option >
28+ < option value ="DSA "> DSA</ option >
29+ < option value ="sds "> SDS</ option >
30+ </ select > < br > </ td >
31+ </ tr >
32+ < tr >
33+ < td > Date of Request:</ td >
34+ < td > < input type ="date " name ="date " required > </ td >
35+ </ tr >
36+ < tr >
37+ < td > Contact number:</ td >
38+ < td > < input type ="tel " pattern =[0-9]{10} name ="phone " required > </ td >
39+ </ tr >
40+ < tr >
41+ < td > Email:</ td >
42+ < td > < input type ="email " name ="email " required > </ td >
43+ </ tr >
44+ < tr >
45+ < td > Confirmation:</ td >
46+ < td > < input type ="checkbox " name ="confirmation " required > I hereby confirm all details are correct</ td >
47+ </ tr >
48+ </ table >
49+ < button type ="submit " name ="submit " > submit</ button >
50+ < button type ="reset " name ="reset "> reset</ button >
51+ </ form >
52+ < script >
53+ document . getElementById ( "form" ) . addEventListener ( "submit" , function ( ) { alert ( "succesfully submitted" ) } ) ;
54+ document . getElementById ( "form" ) . addEventListener ( "reset" , function ( ) { reset ( ) ; } ) ;
55+ </ script >
56+ </ body >
57+ </ html >
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