<?php $__env->startSection('content'); ?>

<p>All fields are required.</p>

<?php if($errors->any()): ?>
<div class="panel fill accent-red dialog" role="dialog" aria-labelledby="form-errors-title" aria-describedby="form-errors-description">
	<h4 id="form-errors-title" class="-puretext">Warning</h4>
	<ol id="form-errors-description" class="list-menu vertical">
		<?php foreach($errors->all() as $error): ?>
              <li><?php echo e($error); ?></li>
        <?php endforeach; ?>
	</ol>
</div>

<?php endif; ?>

<?php echo Form::open(array('url' => '/application/make', 'class'=>'form-basic -form-compact -topline')); ?>

<fieldset>
<?php echo Form::label('firstname', 'First Name'); ?>

<div class="input">
	<?php echo Form::text('firstname',null, array('class'=>($errors->has("firstname")?"small error ":"small"))); ?>

</div>
<br>
<?php echo Form::label('lastname', 'Last Name'); ?>

<div class="input">
<?php echo Form::text('lastname',null,array('class'=>($errors->has("lastname")?"small error":"small"))); ?>

</div>
<br>
<?php echo Form::label('email', 'Email'); ?>

<div class="input">
<?php echo Form::text('email',null,array('class'=>($errors->has("email")?"medium error":"medium"))); ?>

</div>
<br>
<?php echo Form::label('reason', 'Reason for Request (eg. Course/Workshop Name, Instructor Name)'); ?>

<div class="input">
<?php echo Form::textarea('reason',null,array('class'=>($errors->has("reason")?"medium error":"medium"),'rows'=>4,'cols'=>40)); ?>

</div>
</fieldset>
<br>
<div style="float:right;"><?php echo Form::submit('Submit Form'); ?></div>
<?php echo Form::close(); ?>

<?php $__env->stopSection(); ?>


<?php echo $__env->make('layout', array_except(get_defined_vars(), array('__data', '__path')))->render(); ?>