DAHLIA Pattern Library

Application Contact: Error 

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<section class="app-container">
    <div class="row collapse">
        <div class="medium-6 medium-centered columns fixed-width">
            <div class="app-header app-card form-card">
                <header class="app-card_header">
                    <h1 class="app-card_title">Application: 123 Main St.</h1>
                </header>
                <div class="app-card_nav">
                    <ol class="progress-nav">
                        <li class="progress-nav_item active"><a href="#">You</a></li>
                        <li class="progress-nav_item disabled"><a href="#">Household</a></li>
                        <li class="progress-nav_item disabled"><a href="#">Preferences</a></li>
                        <li class="progress-nav_item disabled"><a href="#">Income</a></li>
                        <li class="progress-nav_item disabled"><a href="#">Review</a></li>
                    </ol>
                </div>
            </div>
            <form class="app-card form-card">

                <div class="app-inner leader border-bottom">
                    <div class="form-back"><a href="#" class="lined">Back</a></div>
                    <h2 class="app-card_question">Thanks, Lara. Now we need to know how to contact you about your application.</h2>
                </div>

                <div data-alert class="alert-box alert invert">
                    <p class="alert-body">
                        You&#x27;ll need to resolve any errors before moving on.
                    </p>
                    <a href="#" class="close ">&times;</a>
                </div>

                <div class="app-inner inset border-bottom">
                    <div class="form-group has-option">
                        <div class="form-tel">
                            <label for="tel_1" class="">Your phone number</label>
                            <input type="tel" class="caps" placeholder="555-555-5555" />
                        </div>
                        <div class="form-item padding-bottom">
                            <div class="checkbox">
                                <input id="apple-pie" type="checkbox" name="apple-pie" checked="" />
                                <label for="apple-pie">I don't have a telephone number</label>
                            </div>
                            <small class="highlight">We’ll require an alternate contact phone number on a later screen</small>
                        </div>
                    </div>
                </div>

                <div class="app-inner inset border-bottom">
                    <div class="form-group has-option error">
                        <label class="form-label caps">Your email address</label>
                        <p class="form-note margin-bottom">We will only use your email address to contact you about your application.</p>
                        <div class="form-email">
                            <label for="email" class="sr-only">Email Address</label>
                            <input type="email" placeholder="you@myemail.com" class="error" />
                        </div>
                        <small class="error">Please enter email address</small>

                        <div class="form-item padding-bottom">
                            <div class="checkbox">
                                <input id="peach-pie" type="checkbox" name="peach-pie" tab-index="1" />
                                <label for="peach-pie">I don&#x27;t have an email address</label>
                                <input id="pear-pie" type="checkbox" name="pear-pie" tab-index="2" />
                                <label for="pear-pie">I don&#x27;t have an email address</label>
                            </div>
                        </div>
                    </div>
                </div>

                <div class="app-inner inset border-bottom">
                    <div class="form-group row has-option">
                        <label class="form-label caps">Your address</label>
                        <p class="form-note margin-bottom">Ideally this is an address where we can send updates about your application.</p>
                        <div class="form-address row expand">
                            <div class="form-group-street form-item large-12 columns error">
                                <label for="address" class="sr-only">Address</label>
                                <input type="text" name="address" placeholder="Street Address" class="error" />
                                <small class="error">Please enter a street address</small>
                            </div>

                            <div class="form-group-apt form-item large-12 columns">
                                <label for="address2" class="sr-only">Address 2</label>
                                <input type="text" name="address2" placeholder="Apt or Unit #" class="" />
                            </div>

                            <div class="form-group-city form-item small-7 columns error">
                                <label for="city" class="sr-only">City</label>
                                <input type="text" name="city" placeholder="City Name" class="error" />
                                <small class="error">Please enter a street address</small>
                            </div>

                            <div class="form-group-state form-item small-5 columns">
                                <label for="state" class="sr-only">State</label>
                                <label for="state" class="sr-only">Label</label>
                                <select name="state" id="state" class="" data-width="auto">
                  <option value="">Select</option>
                    <option value="1">Option 1</option>
                	<option value="2">Option 2</option>
                	<option value="3">Option 3</option>
                	<option value="4">Option 4</option>
                	<option value="5">Option 5</option>
                	<option value="6">Option 6</option>
                </select> </div>

                            <div class="form-group-zip form-item small-12 columns">
                                <label for="zip" class="sr-only">Zip</label>
                                <input type="text" name="zip" placeholder="Zip Code" class="" />
                            </div>
                        </div>

                        <div class="form-item padding-bottom">
                            <div class="radio">
                                <input type="radio" name="groupName" id="radio1" />
                                <label for="radio1">I don't have an address</label>
                            </div>
                        </div>

                        <div class="form-item padding-bottom">
                            <div class="radio">
                                <input type="radio" name="groupName" id="radio2" />
                                <label for="radio2">I have a seperate mailing address</label>
                            </div>
                        </div>
                    </div>

                    <div class="form-group row">
                        <label class="form-label caps">Mailing address</label>
                        <p class="form-note margin-bottom">Provide an address where you can receive updates and materials about your application.</p>
                        <div class="form-address row expand">
                            <div class="form-group-street large-12 columns">
                                <label for="address" class="sr-only">Address</label>
                                <input type="text" name="address" placeholder="Street Address" class="expand" />
                            </div>
                            <div class="form-group-apt large-12 columns">
                                <label for="address2" class="sr-only">Address 2</label>
                                <input type="text" name="address2" placeholder="Apt or Unit #" class="expand" />
                            </div>
                            <div class="small-7 columns">
                                <label for="city" class="sr-only">City</label>
                                <input type="text" name="city" placeholder="City Name" class="expand" />
                            </div>
                            <div class="small-5 columns">
                                <label for="state" class="sr-only">State</label>
                                <label for="state" class="sr-only">Label</label>
                                <select name="state" id="state" class="expand" data-width="auto">
                  <option value="">Select</option>
                    <option value="1">Option 1</option>
                	<option value="2">Option 2</option>
                	<option value="3">Option 3</option>
                	<option value="4">Option 4</option>
                	<option value="5">Option 5</option>
                	<option value="6">Option 6</option>
                </select> </div>
                            <div class="small-12 columns">
                                <label for="zip" class="sr-only">Zip</label>
                                <input type="text" name="zip" placeholder="Zip Code" class="expand" />
                            </div>
                        </div>
                    </div>
                </div>

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              <option value="">Select one</option>
                <option value="1">Option 1</option>
            	<option value="2">Option 2</option>
            	<option value="3">Option 3</option>
            	<option value="4">Option 4</option>
            	<option value="5">Option 5</option>
            	<option value="6">Option 6</option>
            </select> </div>
                </div>

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<section class="app-container">
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      {{ render '@app-header' }}
      <form class="app-card form-card">

        <div class="app-inner leader border-bottom">
          <div class="form-back"><a href="#" class="lined">Back</a></div>
          <h2 class="app-card_question">Thanks, Lara. Now we need to know how to contact you about your application.</h2>
        </div>

        {{> @alert-box classes="invert"}}

        <div class="app-inner inset border-bottom">
          <div class="form-group has-option">
            {{> @input-tel classes="caps"}}

            <div class="form-item padding-bottom">
              <div class="checkbox">
                <input id="apple-pie" type="checkbox" name="apple-pie" checked="" />
                <label for="apple-pie">I don't have a telephone number</label>
              </div>
              <small class="highlight">We’ll require an alternate contact phone number on a later screen</small>
            </div>
          </div>
        </div>

        <div class="app-inner inset border-bottom">
          <div class="form-group has-option error">
            <label class="form-label caps">Your email address</label>
            <p class="form-note margin-bottom">We will only use your email address to contact you about your application.</p>
            {{> @input-email visibility="sr-only" classes="error"}}
            <small class="error">Please enter email address</small>

            <div class="form-item padding-bottom">
              {{> @checkbox text="I don't have an email address"}}
            </div>
          </div>
        </div>

        <div class="app-inner inset border-bottom">
          <div class="form-group row has-option">
            <label class="form-label caps">Your address</label>
            <p class="form-note margin-bottom">Ideally this is an address where we can send updates about your application.</p>
            <div class="form-address row expand">
              <div class="form-group-street form-item large-12 columns error">
                  <label for="address" class="sr-only">Address</label>
                  <input type="text" name="address" placeholder="Street Address" class="error" />
                  <small class="error">Please enter a street address</small>
              </div>

              <div class="form-group-apt form-item large-12 columns">
                <label for="address2" class="sr-only">Address 2</label>
                <input type="text" name="address2" placeholder="Apt or Unit #" class=""/>
              </div>

              <div class="form-group-city form-item small-7 columns error">
                <label for="city" class="sr-only">City</label>
                <input type="text" name="city" placeholder="City Name" class="error"/>
                <small class="error">Please enter a street address</small>
              </div>

              <div class="form-group-state form-item small-5 columns">
                <label for="state" class="sr-only">State</label>
                {{> @select name="state" placeholder="Select" options=inputs.states}}
              </div>

              <div class="form-group-zip form-item small-12 columns">
                <label for="zip" class="sr-only">Zip</label>
                <input type="text" name="zip" placeholder="Zip Code" class=""/>
              </div>
            </div>

            <div class="form-item padding-bottom">
              <div class="radio">
                <input type="radio" name="groupName" id="radio1" />
                <label for="radio1">I don't have an address</label>
              </div>
            </div>

            <div class="form-item padding-bottom">
              <div class="radio">
                <input type="radio" name="groupName" id="radio2" />
                <label for="radio2">I have a seperate mailing address</label>
              </div>
            </div>
          </div>

          <div class="form-group row">
            <label class="form-label caps">Mailing address</label>
            <p class="form-note margin-bottom">Provide an address where you can receive updates and materials about your application.</p>
            {{> @input-address classes="expand" visibility="sr-only"}}
          </div>
        </div>

        <div class="app-inner inset">
          <div class="form-group">
            <label class="form-label caps">What is your primary language?</label>
            {{> @select}}
          </div>
        </div>

        {{> @button-pager left="Next" l-classes="primary" right="Save and finish later" r-classes="button-link button-lined small-text-center expand-small"}}
      </form>
    </div>
  </div>
</section>

{{> @footer}}
 
{
  "page-class": "center-body",
  "sections": [
    {
      "header": "You",
      "info-items": [
        {
          "name": "Name",
          "value": "Laura Smith"
        },
        {
          "name": "Date of Birth",
          "value": "12/02/1980"
        },
        {
          "name": "Phone",
          "value": "415-123-1234",
          "note": "Cell"
        },
        {
          "name": "Additional Phone",
          "value": "415-123-1234",
          "note": "Home"
        },
        {
          "name": "Email",
          "value": "lara.smith@gmail.com"
        },
        {
          "name": "Address",
          "value": "649 Avalon St <br> San Francisco, CA 94117"
        },
        {
          "name": "Mailing Address",
          "value": "456 Mission St <br> San Francisco, CA 94117"
        }
      ]
    },
    {
      "header": "Alternate Contact",
      "info-items": [
        {
          "name": "Name",
          "value": "Michael Smith",
          "note": "Counselor",
          "secondary": "MEDA"
        },
        {
          "name": "Email",
          "value": "michael.smith@gmail.com"
        },
        {
          "name": "Phone",
          "value": "415-876-5432"
        },
        {
          "name": "Mailing Address",
          "value": "456 Mission St <br> San Francisco, CA 94117"
        }
      ]
    },
    {
      "header": "Household Members",
      "info-items": [
        {
          "name": "Name",
          "value": "Michael Smith",
          "note": "Child"
        },
        {
          "name": "Date of Birth",
          "value": "12/2/1980"
        },
        {
          "divider": true
        },
        {
          "name": "Name",
          "value": "Michael Johnson",
          "note": "Family Member"
        },
        {
          "name": "Date of Birth",
          "value": "12/2/1970"
        },
        {
          "name": "Address",
          "value": "700 Avalon St <br> San Francisco, CA 94117"
        }
      ]
    },
    {
      "header": "Household Details",
      "info-items": [
        {
          "name": "Rent at 2106 Park Blvd",
          "value": "$1200 per month",
          "note": "for Michael Smith"
        },
        {
          "name": "Rent at 4106 Terrace St",
          "value": "$1200 per month",
          "note": "for Jane Smith and Denise Jones"
        },
        {
          "name": "Seniors in Household",
          "value": "Yes"
        },
        {
          "name": "Veterans in Household",
          "value": "Yes"
        },
        {
          "name": "People with Developmental Disabilities",
          "value": "Yes"
        },
        {
          "name": "ADA Accessible Units",
          "value": "Mobility Impairments<br> Visual Impairments"
        }
      ]
    },
    {
      "header": "Income",
      "info-items": [
        {
          "name": "Vouchers and Subsidies",
          "value": "Yes"
        },
        {
          "name": "Household Income",
          "value": "$32,000 per year"
        }
      ]
    },
    {
      "header": "Preferences",
      "info-items": [
        {
          "name": "You Have Claimed",
          "value": "Certificate of Preference",
          "note": "for Michael Smith"
        },
        {
          "name": "You Have Claimed",
          "value": "Neighborhood Resident Housing Preference",
          "note": "for Michael Smith",
          "secondary": "Telephone Bill attached"
        },
        {
          "name": "You Have Claimed",
          "value": "Rent Burden Preference",
          "note": "for 2106 Park Blvd",
          "secondary": "Copy of Lease and Cancelled Check attached",
          "note-2": "for 4106 Terrace St",
          "secondary-2": "Copy of Lease and Money order attached"
        }
      ]
    }
  ],
  "sections-general": [
    {
      "header": "You",
      "info-items": [
        {
          "name": "Name",
          "value": "Laura Smith"
        },
        {
          "name": "Date of Birth",
          "value": "12/02/1980"
        },
        {
          "name": "Phone",
          "value": "415-123-1234",
          "note": "Cell"
        },
        {
          "name": "Additional Phone",
          "value": "415-123-1234",
          "note": "Home"
        },
        {
          "name": "Email",
          "value": "lara.smith@gmail.com"
        },
        {
          "name": "Address",
          "value": "649 Avalon St <br> San Francisco, CA 94117"
        },
        {
          "name": "Mailing Address",
          "value": "456 Mission St <br> San Francisco, CA 94117"
        }
      ]
    },
    {
      "header": "Alternate Contact",
      "info-items": [
        {
          "name": "Name",
          "value": "Michael Smith",
          "note": "Counselor",
          "secondary": "MEDA"
        },
        {
          "name": "Email",
          "value": "michael.smith@gmail.com"
        },
        {
          "name": "Phone",
          "value": "415-876-5432"
        },
        {
          "name": "Mailing Address",
          "value": "456 Mission St <br> San Francisco, CA 94117"
        }
      ]
    },
    {
      "header": "Household Members",
      "info-items": [
        {
          "name": "Name",
          "value": "Michael Smith",
          "note": "Child"
        },
        {
          "name": "Date of Birth",
          "value": "12/2/1980"
        },
        {
          "divider": true
        },
        {
          "name": "Name",
          "value": "Michael Johnson",
          "note": "Family Member"
        },
        {
          "name": "Date of Birth",
          "value": "12/2/1970"
        },
        {
          "name": "Address",
          "value": "700 Avalon St <br> San Francisco, CA 94117"
        }
      ]
    },
    {
      "header": "Preferences",
      "info-items": [
        {
          "name": null,
          "value": "Based on the information you have entered, your household has not claimed any housing lottery preferences. you will be in the general lottery.",
          "is-sentence": "yes"
        }
      ]
    },
    {
      "header": "Income",
      "info-items": [
        {
          "name": "Vouchers and Subsidies",
          "value": "No"
        },
        {
          "name": "Household Income",
          "value": "$32,000 per year"
        }
      ]
    }
  ],
  "sections-preview": [
    {
      "header": "You",
      "info-items": [
        {
          "name": "Name",
          "value": "Laura Smith"
        },
        {
          "name": "Date of Birth",
          "value": "12/02/1980"
        },
        {
          "name": "Phone",
          "value": "415-123-1234",
          "note": "Cell"
        },
        {
          "name": "Additional Phone",
          "value": "415-123-1234",
          "note": "Home"
        },
        {
          "name": "Email",
          "value": "lara.smith@gmail.com"
        },
        {
          "name": "Address",
          "value": "649 Avalon St <br> San Francisco, CA 94117"
        },
        {
          "name": "Mailing Address",
          "value": "456 Mission St <br> San Francisco, CA 94117"
        }
      ]
    },
    {
      "header": "Alternate Contact",
      "info-items": [
        {
          "name": "Name",
          "value": "Michael Smith",
          "note": "Counselor",
          "secondary": "MEDA"
        },
        {
          "name": "Email",
          "value": "michael.smith@gmail.com"
        },
        {
          "name": "Phone",
          "value": "415-876-5432"
        },
        {
          "name": "Mailing Address",
          "value": "456 Mission St <br> San Francisco, CA 94117"
        }
      ]
    },
    {
      "header": "Household Members",
      "info-items": [
        {
          "name": "Name",
          "value": "Michael Smith",
          "note": "Child"
        },
        {
          "name": "Date of Birth",
          "value": "12/2/1980"
        },
        {
          "divider": true
        },
        {
          "name": "Name",
          "value": "Michael Johnson",
          "note": "Family Member"
        },
        {
          "name": "Date of Birth",
          "value": "12/2/1970"
        },
        {
          "name": "Address",
          "value": "700 Avalon St <br> San Francisco, CA 94117"
        }
      ]
    },
    {
      "header": "Household Details",
      "info-items": [
        {
          "name": "Seniors in Household",
          "value": "Yes"
        },
        {
          "name": "Veterans in Household",
          "value": "Yes"
        },
        {
          "name": "People with Developmental Disabilities",
          "value": "Yes"
        }
      ]
    }
  ]
}

There are no notes for this item.