&lt;form id=&quot;form-app&quot; enctype=&quot;multipart/form-data&quot;&gt;
&lt;fieldset&gt;

&lt;!-- Heading --&gt;
&lt;h3 class=&quot;legend&quot;&gt;Bug Tracker&lt;/h3&gt;

&lt;!-- Paragraph Text --&gt;
&lt;p&gt;Report all bugs!&lt;/p&gt;

&lt;!-- Text --&gt;
&lt;div class=&quot;form-group required-control&quot;&gt;
    &lt;label class=&quot;control-label&quot; for=&quot;text_0&quot;&gt;Bug Title&lt;/label&gt;
    &lt;input type=&quot;text&quot; id=&quot;text_0&quot; name=&quot;text_0&quot; class=&quot;form-control&quot; required=&quot;&quot;&gt;
&lt;/div&gt;

&lt;!-- Text Area --&gt;
&lt;div class=&quot;form-group required-control&quot;&gt;
    &lt;label class=&quot;control-label&quot; for=&quot;textarea_0&quot;&gt;Issue Description&lt;/label&gt;
    &lt;textarea id=&quot;textarea_0&quot; name=&quot;textarea_0&quot; rows=&quot;3&quot; class=&quot;form-control&quot; required=&quot;&quot;&gt;&lt;/textarea&gt;
&lt;/div&gt;

&lt;!-- Select List --&gt;
&lt;div class=&quot;form-group required-control col-xs-6&quot;&gt;
    &lt;label class=&quot;control-label&quot; for=&quot;selectlist_0&quot;&gt;Operating System&lt;/label&gt;
    &lt;select id=&quot;selectlist_0&quot; name=&quot;selectlist_0[]&quot; class=&quot;form-control&quot; required=&quot;&quot;&gt;
        &lt;option value=&quot;&quot; disabled=&quot;&quot; selected=&quot;&quot;&gt;-Select-&lt;/option&gt;
        &lt;option value=&quot;Windows XP&quot;&gt;Windows XP&lt;/option&gt;
        &lt;option value=&quot;Windows Vista&quot;&gt;Windows Vista&lt;/option&gt;
        &lt;option value=&quot;Mac OS X&quot;&gt;Mac OS X&lt;/option&gt;
        &lt;option value=&quot;Linux&quot;&gt;Linux&lt;/option&gt;
        &lt;option value=&quot;Other&quot;&gt;Other&lt;/option&gt;
    &lt;/select&gt;
&lt;/div&gt;

&lt;!-- Select List --&gt;
&lt;div class=&quot;form-group required-control col-xs-6&quot;&gt;
    &lt;label class=&quot;control-label&quot; for=&quot;selectlist_1&quot;&gt;Browser&lt;/label&gt;
    &lt;select id=&quot;selectlist_1&quot; name=&quot;selectlist_1[]&quot; class=&quot;form-control&quot; required=&quot;&quot;&gt;
        &lt;option value=&quot;&quot; disabled=&quot;&quot; selected=&quot;&quot;&gt;-Select-&lt;/option&gt;
        &lt;option value=&quot;Internet Explorer&quot;&gt;Internet Explorer&lt;/option&gt;
        &lt;option value=&quot;Chrome&quot;&gt;Chrome&lt;/option&gt;
        &lt;option value=&quot;Firefox&quot;&gt;Firefox&lt;/option&gt;
        &lt;option value=&quot;Safari&quot;&gt;Safari&lt;/option&gt;
        &lt;option value=&quot;Opera&quot;&gt;Opera&lt;/option&gt;
        &lt;option value=&quot;Other&quot;&gt;Other&lt;/option&gt;
    &lt;/select&gt;
&lt;/div&gt;

&lt;!-- Select List --&gt;
&lt;div class=&quot;form-group required-control col-xs-9&quot;&gt;
    &lt;label class=&quot;control-label&quot; for=&quot;selectlist_3&quot;&gt;Assign To&lt;/label&gt;
    &lt;select id=&quot;selectlist_3&quot; name=&quot;selectlist_3[]&quot; class=&quot;form-control&quot; required=&quot;&quot;&gt;
        &lt;option value=&quot;&quot; disabled=&quot;&quot; selected=&quot;&quot;&gt;-Select-&lt;/option&gt;
        &lt;option value=&quot;Team Member #1&quot;&gt;Team Member #1&lt;/option&gt;
        &lt;option value=&quot;Team Member #2&quot;&gt;Team Member #2&lt;/option&gt;
        &lt;option value=&quot;Team Member #3&quot;&gt;Team Member #3&lt;/option&gt;
    &lt;/select&gt;
&lt;/div&gt;

&lt;!-- Select List --&gt;
&lt;div class=&quot;form-group required-control col-xs-3&quot;&gt;
    &lt;label class=&quot;control-label&quot; for=&quot;selectlist_8&quot;&gt;Priority&lt;/label&gt;
    &lt;select id=&quot;selectlist_8&quot; name=&quot;selectlist_8[]&quot; class=&quot;form-control&quot; required=&quot;&quot;&gt;
        &lt;option value=&quot;&quot; disabled=&quot;&quot; selected=&quot;&quot;&gt;-Select-&lt;/option&gt;
        &lt;option value=&quot;Low&quot;&gt;Low&lt;/option&gt;
        &lt;option value=&quot;Medium&quot;&gt;Medium&lt;/option&gt;
        &lt;option value=&quot;High&quot;&gt;High&lt;/option&gt;
    &lt;/select&gt;
&lt;/div&gt;

&lt;!-- File --&gt;
&lt;div class=&quot;form-group&quot;&gt;
    &lt;label class=&quot;control-label&quot; for=&quot;file_0&quot;&gt;Upload a Screenshot&lt;/label&gt;
    &lt;input type=&quot;file&quot; id=&quot;file_0&quot; name=&quot;file_0&quot; accept=&quot;.gif, .jpg, .png&quot;&gt;
&lt;/div&gt;

&lt;!-- Select List --&gt;
&lt;div class=&quot;form-group required-control&quot;&gt;
    &lt;label class=&quot;control-label&quot; for=&quot;selectlist_9&quot;&gt;Status&lt;/label&gt;
    &lt;select id=&quot;selectlist_9&quot; name=&quot;selectlist_9[]&quot; class=&quot;form-control&quot; required=&quot;&quot;&gt;
        &lt;option value=&quot;&quot; disabled=&quot;&quot; selected=&quot;&quot;&gt;-Select-&lt;/option&gt;
        &lt;option value=&quot;New&quot;&gt;New&lt;/option&gt;
        &lt;option value=&quot;Acknowledged&quot;&gt;Acknowledged&lt;/option&gt;
        &lt;option value=&quot;Confirmed&quot;&gt;Confirmed&lt;/option&gt;
        &lt;option value=&quot;Assigned&quot;&gt;Assigned&lt;/option&gt;
        &lt;option value=&quot;Resolved&quot;&gt;Resolved&lt;/option&gt;
        &lt;option value=&quot;Closed&quot;&gt;Closed&lt;/option&gt;
    &lt;/select&gt;
&lt;/div&gt;

&lt;!-- Button --&gt;
&lt;div class=&quot;form-action&quot;&gt;
    &lt;input type=&quot;submit&quot; id=&quot;button_0&quot; name=&quot;button_0&quot; class=&quot;btn btn-primary&quot; value=&quot;Submit&quot;&gt;
&lt;/div&gt;

&lt;/fieldset&gt;
&lt;/form&gt;