<div class="page-content">
                            <ol class="breadcrumb">
                                
<li><a href="index.html">Home</a></li>
<li><a href="#">Advanced Forms</a></li>
<li class="active"><a href="ui-forms.html">Form Components</a></li>

                            </ol>
                            <div class="container-fluid">
                                

<div data-widget-group="group1" class="ui-sortable">

	<div class="panel panel-default" data-widget="{&quot;draggable&quot;: &quot;false&quot;}" data-widget-static="" style="visibility: visible; opacity: 1; display: block; transform: translateY(0px);">
		<div class="panel-heading">
			<h2>Add Lead</h2>
			<div class="panel-ctrls" data-actions-container="" data-action-collapse="{&quot;target&quot;: &quot;.panel-body&quot;}"><span class="button-icon has-bg"><i class="ti ti-angle-down"></i></span></div>
		</div>
		<div class="panel-editbox" data-widget-controls=""></div>
		<div class="panel-body">
		  <form action="action-pages/telecaller/generate-sid-action.php" class="form-horizontal row-border" method="post">
				<div class="form-group">
					<label class="col-sm-2 control-label" style="text-align:left">Student Name</label>
					<div class="col-sm-8">
						<input type="text" class="form-control" placeholder="Enter Student Name" name="student_name" required>
					</div>
				</div>
				<div class="form-group">
					<label class="col-sm-2 control-label" style="text-align:left">Enter Mobile No</label>
					<div class="col-sm-8">
						<input type="text" class="form-control" placeholder="Enter Mobile No" name="mobile" required>
					</div>
				</div>
		    <div class="form-group">
					<label class="col-sm-2 control-label" style="text-align:left">Enter Email Id</label>
					<div class="col-sm-8">
						<input type="text" class="form-control" placeholder="Enter Email Id" name="email" required>
					</div>
			  </div>
			  <div class="form-group">
			    <label class="col-sm-2 control-label" style="text-align:left">Course</label>
					<div class="col-sm-8">
						<select name="course" class="form-control" required>
                        <option value="">SELECT COURSE</option>
                       <?php
					   $GetLIst=mysql_query("SELECT * FROM  `sgvu_courses` WHERE  `status` =1 ORDER BY  `course_type` ASC ,  `finance_school` ASC");
					   while($GetLIst1=mysql_fetch_assoc($GetLIst))
					   {
					   ?>
						
                        <option value="<?php echo $GetLIst1['course_id']; ?>"><?php echo $GetLIst1['coursename']; ?></option>
                        
                       <?php } ?>
                        
                        </select>
					</div>
		    </div>
            
            <div class="form-group">
			    <label class="col-sm-2 control-label" style="text-align:left">Source</label>
					<div class="col-sm-8">
						<select name="source" class="form-control" id="source" required>
                        <option value="">SELECT SOURCE</option>
                        <option value="1">Online Chat</option>
                        <option value="2">Walk-In</option>
                        <option value="3">Facebook Chat</option>
                        <option value="4">Telephonic</option>
                        <option value="5">Other</option>
                        </select>
					</div>
		    </div>
            <button class="btn-primary btn" type="submit">Submit</button>
					<button class="btn-default btn">Cancel</button>

			</form>
			
		</div>
		<div class="panel-footer">
			<div class="row">
				<div class="col-sm-8 col-sm-offset-2">
									</div>
			</div>
		</div>
	</div>
</div>


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