form.html

<div class="panel panel-default">
  <div class="panel-heading">
    <h3 class="panel-title">Comment</h3>
  </div>
  <div class="panel-body">
    <div class="form-group" data-role="fieldcontain">
      <label for="issue_type">Comment Type</label>
      <select class="form-control" name="issue_type" id="issue_type" data-errormessage='{"valueMissing": "This is a required field"}' required>
        <option value=""></option>
        <!-- the options are being set in the app.js now since different instances have diff options, the db constraint has been removed as well -->
      </select>
    </div>


    <!-- TODO - select airport - required field -->
    <div class="form-group" data-role="fieldcontain">
      <label for="airport_select">Select Airport</label>
<!--       <select class="form-control" name="airport_select" id="airport_select" data-errormessage='{"valueMissing": "This is a required field"}' required>
        <option value=""></option>
      </select> -->

      <div id="AirportSelect">
        <input class="typeahead" type="text" placeholder="Must Select Airport" required>
      </div>
    </div>


    <div class="form-group " data-role="fieldcontain">
      <label for="date_reported">Date Reported</label>
      <input type="date" class="form-control" name="date_reported" id="date_reported" value="<?php echo date('Y-m-d'); ?>" data-errormessage='{"valueMissing": "This is a required field"}' >
    </div>
    <div class="form-group hidden" data-role="fieldcontain">
      <label for="issue_address">Issue Address</label>
      <input class="form-control" type="text" name="issue_address" id="issue_address" data-errormessage='{"valueMissing": "This is a required field"}' >
    </div>
    <div class="form-group hidden" data-role="fieldcontain">
      
      <!-- This list must be inclusive of the list found in the config.json for the app to work -->
      <label for="issue_city">Issue City</label>
      <select class="form-control" name="issue_city" id="issue_city" data-errormessage='{"valueMissing": "This is a required field"}' >
        <option value=""></option>
        <option value="Andover">Andover</option>
        <option value="Fridley">Fridley</option>
        <option value="St Paul">St Paul</option>
        <option value="Roseville">Roseville</option>
        <option value="Fairbanks">Fairbanks</option>
        <option value="Haines">Haines</option>
        <option value="HainesFLU">HainesFLU</option>
        <option value="HomerPlan">HomerPlan</option>
        <option value="Kodiak">Kodiak</option>
        <option value="Matsuborough">Matsuborough</option>
        <option value="AlaskaAirports">AlaskaAirports</option>
        <option value="MVPMPO">MVPMPO</option>
      </select>

      <label for="issue_state">Issue State</label>
      <input class="form-control" type="text" name="issue_state" id="issue_state" value="" readonly data-errormessage='{"valueMissing": "This is a required field"}' >
    </div>
    <div class="form-group hidden" data-role="fieldcontain">
      <label for="is_resident">Are you a resident of the city?</label>
      <select class="form-control" name="is_resident" id="is_resident" data-errormessage='{"valueMissing": "This is a required field"}' >
        <option value=""></option>
        <option value="No">No</option>
        <option value="Yes">Yes</option>
      </select>
    </div>
    <div class="form-group" data-role="fieldcontain">
      <!-- <label for="notes">Comment</label> -->
      <textarea class="form-control" rows="3" name="notes" id="notes" data-errormessage='{"valueMissing": "Specific details required."}' required></textarea>
    </div>
    <div class="form-group hidden">
      <label for="uploads">Photos (photos are strongly encouraged!)</label>
      <input type="file" id="uploads" name="uploads[]" accept="image/*">
    </div>
  </div>
</div>
<div class="panel panel-default">
  <div class="panel-heading">
    <h3 class="panel-title">Submitter Information</h3>
  </div>
  <div class="panel-body">
    <p>Please provide your name and contact information. Everything is confidential and will never be shared.</p>
	<div class="form-group" data-role="fieldcontain">
      <label for="submitter_name">Name</label>
      <input class="form-control" type="text" name="submitter_name" id="submitter_name" placeholder="(Optional)">
    </div>
    <div class="form-group" data-role="fieldcontain">
      <label for="submitter_email">Email</label>
      <input class="form-control" type="email" name="submitter_email" id="submitter_email" placeholder="(Optional)" data-errormessage='{"valueMissing": ""}' >
    </div>
	<div class="form-group" data-role="fieldcontain">
      <label for="submitter_phone">Phone</label>
      <input class="form-control" type="text" name="submitter_phone" id="submitter_phone" placeholder="(Optional)" >
    </div>
  </div>
</div>