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<head>
<meta http-equiv="Content-Type" content="text/html; charset=windows-1254">
<link rel="stylesheet" type="text/css" href="images/stil.css"/>

<title>&Ouml;zel Ders Talep Formu</title>
<Meta name="description" content=" Özel ders verenler ve özel ders ilanları'nı içeren sitemiz ile kolaylıkla yüzlerce seçkin özel öğretmen'e hemen ulaşın.">  
<meta name="keywords" content="özel ders, özel ders verenler, özel öğretmen, özel ders ilanları, özel ders vermek istiyorum"> 
<style type="text/css">
.style1 {
	text-align: left;
}
</style>
<script type="text/javascript">
							function kontrol() {
								var formgonderi = document.getElementById("kayitform");
								var adsoyad = formgonderi.adsoyad.value;
								var tel = formgonderi.tel.value;
								var aciklama = formgonderi.textareaa.value;
								var ders = formgonderi.ders.value;
								var sehir = formgonderi.sehir.value;
								if(adsoyad=="") {
									alert("Lütfen Ad-Soyad Kısmını Doldurunuz");
									return false;
								}
								if(tel=="") {
									alert("Lütfen Telefon Kısmını Doldurunuz");
									return false;
								}
								if(aciklama=="") {
									alert("Lütfen Açıklama Kısmını Doldurunuz");
									return false;
								}
								if(ders=="") {
									alert("Lütfen Ders Seçiniz");
									return false;
								}
								if(sehir=="") {
									alert("Lütfen Şehir Seçiniz");
									return false;
								}
								formgonderi.submit();
							}
							</script>
</head>

<body>





<div align="center">
	<table border="0" width="952" cellpadding="0" style="border-collapse: collapse">
		<tr>
			<td width="201">
			<img border="0" src="images/ana-_02.png" width="335" height="120"></td>
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<div align="right" style="margin-right:1px">&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;<a href="default.asp">Anasayfa</a>

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</td>
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				<tr>
					<td style="background-image: url('images/ana-_05.png'); background-repeat: no-repeat" height="46">

<form name="aramaform" id="aramaform" action="arason.asp" method="post">

					<table border="0" width="100%" cellpadding="0" style="border-collapse: collapse" height="46">
						<tr>
							<td align="right" width="52">&nbsp;
							</td>
							<td align="center" valign="middle">
<select name="derskategori">
<option selected>Ders Seçiniz</option>

<option value="11">Almanca</option>

<option value="27">Beden Eğitimi</option>

<option value="9">Biyoloji</option>

<option value="19">Coğrafya</option>

<option value="14">Çince</option>

<option value="23">Diksiyon</option>

<option value="26">Direksiyon</option>

<option value="17">Edebiyat</option>

<option value="4">Enstrüman</option>

<option value="21">Felsefe</option>

<option value="7">Fen ve Teknoloji</option>

<option value="6">Fizik</option>

<option value="3">Fransızca</option>

<option value="10">Geometri</option>

<option value="30">Gitar</option>

<option value="28">Güzel Sanatlar</option>

<option value="1">İngilizce</option>

<option value="13">İspanyolca</option>

<option value="12">İtalyanca</option>

<option value="31">Keman</option>

<option value="8">Kimya</option>

<option value="2">Matematik</option>

<option value="5">Müzik</option>

<option value="22">Okuma-Yazma</option>

<option value="32">Piyano</option>

<option value="24">Resim</option>

<option value="15">Rusça</option>

<option value="20">Sosyal Bilgiler</option>

<option value="18">Tarih</option>

<option value="16">Türkçe</option>

<option value="25">Web Programlama</option>

</select>
							</td>
							<td width="120" align="center" valign="middle">
						<select name="sehir" style="width: 115px">
						  <option selected>Şehir Seçiniz</option>
							
						  <option value="6"> Adana</option>
                          	
						  <option value="9"> Afyon</option>
                          	
						  <option value="8"> Aksaray</option>
                          	
						  <option value="2"> Ankara</option>
                          	
						  <option value="7"> Antalya</option>
                          	
						  <option value="10"> Aydın</option>
                          	
						  <option value="11"> Bolu</option>
                          	
						  <option value="4"> Bursa</option>
                          	
						  <option value="12"> Çanakkale</option>
                          	
						  <option value="13"> Çankırı</option>
                          	
						  <option value="14"> Denizli</option>
                          	
						  <option value="15"> Düzce</option>
                          	
						  <option value="16"> Edirne</option>
                          	
						  <option value="17"> Eskişehir</option>
                          	
						  <option value="46"> Gaziantep</option>
                          	
						  <option value="18"> Giresun</option>
                          	
						  <option value="19"> Isparta</option>
                          	
						  <option value="1"> İstanbul</option>
                          	
						  <option value="3"> İzmir</option>
                          	
						  <option value="20"> Kahramanmaraş</option>
                          	
						  <option value="21"> Karabük</option>
                          	
						  <option value="22"> Karaman</option>
                          	
						  <option value="23"> Kayseri</option>
                          	
						  <option value="24"> Kırklareli</option>
                          	
						  <option value="25"> Kırşehir</option>
                          	
						  <option value="5"> Kocaeli</option>
                          	
						  <option value="26"> Konya</option>
                          	
						  <option value="27"> Kütahya</option>
                          	
						  <option value="28"> Malatya</option>
                          	
						  <option value="29"> Manisa</option>
                          	
						  <option value="30"> Mersin</option>
                          	
						  <option value="31"> Muğla</option>
                          	
						  <option value="32"> Nevşehir</option>
                          	
						  <option value="33"> Niğde</option>
                          	
						  <option value="34"> Ordu</option>
                          	
						  <option value="35"> Rize</option>
                          	
						  <option value="36"> Sakarya</option>
                          	
						  <option value="37"> Sivas</option>
                          	
						  <option value="38"> Tekirdağ</option>
                          	
						  <option value="39"> Trabzon</option>
                          	
						  <option value="40"> Tunceli</option>
                          	
						  <option value="41"> Van</option>
                          	
						  <option value="42"> Yalova</option>
                          	
						  <option value="43"> Yozgat</option>
                          	
						  <option value="44"> Zonguldak</option>
                          	
					    </select>

							</td>
							<td width="189" align="center" valign="middle">
							<select name="seviye" style="width: 188px">
						  <option selected>Seviye</option>
                          	
						  <option value="1">Okul Öncesi</option>
							
						  <option value="2">İlköğretim (Okula Takviye)</option>
							
						  <option value="3">İlköğretim (SBS)</option>
							
						  <option value="4">Lise (Okula Takviye)</option>
							
						  <option value="5">Lise (ÖSS-YGS-LYS)</option>
							
						  <option value="6">Üniversite (Derslere Takviye)</option>
							
						  <option value="7">Yetişkinler İçin Yabancı Dil</option>
							
						  <option value="8">Yetişkinler İçin Akademik Eğitim</option>
							
						  <option value="9">Yetişkinler İçin Diğer Eğitimler</option>
							
						  <option value="10">ALES, KPSS, DGS, vb.</option>
							
						  <option value="11">GRE, GMAT, vb.</option>
							
						  <option value="12">TOEFL, KPDS, ÜDS, IELTS, vb.</option>
							
						  <option value="13">Diğer</option>
							
                          </select>
							</td>
							<td align="right" width="124">
							<img border="0" src="images/ana-_ara.png" onClick="document.aramaform.submit();"/></td>
						</tr>
					</table>

					
					</form>
					</td>
				</tr>
			</table>
			</td>
		</tr>
		<tr>
			<td width="950" colspan="2" valign="top" style="background-image: url('images/aidat-i_05.png'); background-repeat: no-repeat" height="52">&nbsp;</td>
		</tr>
		<tr>
			<td width="952" colspan="2" valign="top" style="background-image: url('images/aidat-i_06.png'); background-repeat: repeat-y">
			
			<table border="0" width="950" cellpadding="0" style="border-collapse: collapse">
				<tr>
					<td width="713" align="left" valign="top">
					<table border="0" width="713" cellpadding="0" style="border-collapse: collapse">
				<tr>
					<td style="background-image: url('images/aidat-ic_03.png'); background-repeat: no-repeat" width="713" height="18">
					</td>
				</tr>
				<tr>
					<td style="background-image: url('images/aidat-ic_05.png'); background-repeat: no-repeat" width="713" height="25">
					
					<span id="aidatbaslik">&Ouml;zel Ders Talep Formu</span>
					</td>
				</tr>
				<tr>
					<td style="background-image: url('images/aidat-ic_06.png')" width="713" align="center">
					<table id="aidattablo" border="0" width="627" cellpadding="0" style="border-collapse: collapse">
						<tr>
							<td style="background-image: url('images/aidat-ic-ic_03.png'); background-repeat: no-repeat" width="627" height="36" align="left">
							
							<span id="aidattablobaslik"> AÇIKLAMA</span>
							</td>
						</tr>
						<tr>
							<td style="background-image: url('images/aidat-ic-ic_05.png'); background-repeat: repeat-y" width="627" align="left">
							<div id="aidattablodiv">
							<span id="aidattabloyazi">Sitemizde yaptığınız aramalar sonucunda kriterlerinize uygun öğretmen bulamadıysanız aradığınız öğretmeni size yönlendirebilmemiz için aşağıdaki özel ders talep formunu doldurunuz.Sitemizdeki Eğitim danışmanımız size en uygun üye öğretmenlerimizi bilgilendirecektir. Kriterlerinize uygun üye öğretmenlerimiz tahminen 24 saat içerisinde sizinle iletişime geçecektir.</span>
							</div>
							</td>
						</tr>
						<tr>
							<td style="background-image: url('images/aidat-ic-ic_07.png'); background-repeat: no-repeat" width="627" height="19">&nbsp;</td>
						</tr>
					</table>
					<br />
					</td>
				</tr>
				
				<tr>
					<td style="background-image: url('images/aidat-ic_05.png'); background-repeat: no-repeat" width="713" height="25">
					
					<span id="aidatbaslik">DERS TALEP FORMU</span>
					</td>
				</tr>

				<tr>
					<td style="background-image: url('images/aidat-ic_06.png')" width="713" align="center">
					
<form action="derstalep.asp?I=yolla" method="post" name="kayitform" id="kayitform" >
<table id="aidattabloo" border="0" width="620" cellpadding="0" style="border-collapse: collapse">
	<tr>
		<td width="310" valign="top" align="left">Adınız Soyadınız: </td>
		<td width="310" valign="top" align="left">&nbsp;</td>
	</tr>
	<tr>
		<td width="310" valign="top" align="left"><input type="text" name="adsoyad" id="adsoyad"/>
		*</td>
		<td width="310" valign="top" align="left">&nbsp;</td>
	</tr>
	<tr>
		<td width="310" valign="top" align="left">E-Posta Adresiniz: </td>
		<td width="310" valign="top" align="left">Bulunduğunuz Şehir:</td>
	</tr>
	<tr>
		<td width="310" valign="top" align="left"><input type="text" name="mail"/></td>
		<td width="310" valign="top" align="left"><input type="text" name="sehir" id="sehir"/>
		*</td>
	</tr>
	<tr>
		<td width="310" valign="top" align="left">Cep veya Sabit Telefon 
		Numaranız: </td>
		<td width="310" valign="top" align="left">Bulunduğunuz İlçe/Semt:</td>
	</tr>
	<tr>
		<td width="310" valign="top" align="left"><input type="text" name="tel" id="tel"/>
		*</td>
		<td width="310" valign="top" align="left"><input type="text" name="ilcesemt"/></td>
	</tr>
	<tr>
		<td width="310" valign="top" align="left">Talep Ettiğiniz Ders: </td>
		<td width="310" valign="top" align="left">Ders Almak İstediğiniz Günler:</td>
	</tr>
	<tr>
		<td width="310" valign="top" align="left"><select name="ders" id="ders" style="background:#EAEAEA;">
		  <option value="">Ders Kategorisi Seçiniz.</option>
            
		  <option value="11">Almanca</option>
		  
		  <option value="27">Beden Eğitimi</option>
		  
		  <option value="9">Biyoloji</option>
		  
		  <option value="19">Coğrafya</option>
		  
		  <option value="14">Çince</option>
		  
		  <option value="23">Diksiyon</option>
		  
		  <option value="26">Direksiyon</option>
		  
		  <option value="17">Edebiyat</option>
		  
		  <option value="4">Enstrüman</option>
		  
		  <option value="21">Felsefe</option>
		  
		  <option value="7">Fen ve Teknoloji</option>
		  
		  <option value="6">Fizik</option>
		  
		  <option value="3">Fransızca</option>
		  
		  <option value="10">Geometri</option>
		  
		  <option value="30">Gitar</option>
		  
		  <option value="28">Güzel Sanatlar</option>
		  
		  <option value="1">İngilizce</option>
		  
		  <option value="13">İspanyolca</option>
		  
		  <option value="12">İtalyanca</option>
		  
		  <option value="31">Keman</option>
		  
		  <option value="8">Kimya</option>
		  
		  <option value="2">Matematik</option>
		  
		  <option value="5">Müzik</option>
		  
		  <option value="22">Okuma-Yazma</option>
		  
		  <option value="32">Piyano</option>
		  
		  <option value="24">Resim</option>
		  
		  <option value="15">Rusça</option>
		  
		  <option value="20">Sosyal Bilgiler</option>
		  
		  <option value="18">Tarih</option>
		  
		  <option value="16">Türkçe</option>
		  
		  <option value="25">Web Programlama</option>
		  
		    </select>
		  *
		  </td>
		<td width="310" valign="top" align="left"><input type="text" name="gun"/></td>
	</tr>
	<tr>
		<td width="310" valign="top" align="left">Ders Seviyesi:</td>
		<td width="310" valign="top" align="left">Ders Almak İstediğiniz Yer:</td>
	</tr>
	<tr>
		<td width="310" valign="top" align="left"><select name="seviye" style="background:#EAEAEA;">
  <option selected>Seviye Seçiniz.</option>

            
		  <option value="ALES, KPSS, DGS, vb.">ALES, KPSS, DGS, vb.</option>
		  
		  <option value="Diğer">Diğer</option>
		  
		  <option value="GRE, GMAT, vb.">GRE, GMAT, vb.</option>
		  
		  <option value="İlköğretim (Okula Takviye)">İlköğretim (Okula Takviye)</option>
		  
		  <option value="İlköğretim (SBS)">İlköğretim (SBS)</option>
		  
		  <option value="Lise (Okula Takviye)">Lise (Okula Takviye)</option>
		  
		  <option value="Lise (ÖSS-YGS-LYS)">Lise (ÖSS-YGS-LYS)</option>
		  
		  <option value="Okul Öncesi">Okul Öncesi</option>
		  
		  <option value="TOEFL, KPDS, ÜDS, IELTS, vb.">TOEFL, KPDS, ÜDS, IELTS, vb.</option>
		  
		  <option value="Üniversite (Derslere Takviye)">Üniversite (Derslere Takviye)</option>
		  
		  <option value="Yetişkinler İçin Akademik Eğitim">Yetişkinler İçin Akademik Eğitim</option>
		  
		  <option value="Yetişkinler İçin Diğer Eğitimler">Yetişkinler İçin Diğer Eğitimler</option>
		  
		  <option value="Yetişkinler İçin Yabancı Dil">Yetişkinler İçin Yabancı Dil</option>
		  
</select></td>
		<td width="310" valign="top" align="left" style="font-size: 11px"><select name="yer" style="background:#EAEAEA;">
  <option value="Farketmez">Farketmez</option>
<option value="Öğrencinin Evi">Öğrencinin Evi</option>
<option value="Öğretmenin Evi">Öğretmenin Evi</option>
<option value="Özel Ders Bürosu">Özel Ders Bürosu</option>
</select>
</td>
	</tr>
	<tr>
		<td width="310" valign="top" align="left">Kabul Edebileceğiniz Saat 
		Ücreti:</td>
		<td width="310" valign="top" align="left">Ders Almak İstediğiniz 
		Saat Aralıkları:</td>
	</tr>
	<tr>
		<td width="310" valign="top" align="left"><input type="text" name="ucret"/></td>
		<td width="310" valign="top" align="left"><input type="text" name="saat"/></td>
	</tr>
	<tr>
		<td width="620" valign="top" colspan="2" class="style1">Varsa Eklemek İstedikleriniz: *
		  <textarea id="textareaa" name="aciklama"></textarea></td>
	</tr>
	<tr>
		<td width="310" valign="top" align="left">&nbsp;</td>
		<td width="310" valign="top" align="left">&nbsp;</td>
	</tr>
	<tr>
		<td width="310" valign="top" align="left">&nbsp;</td>
		<td width="310" valign="top" align="center">
		<img border="0" src="images/il-i_03.png" onClick="kontrol();"/></td>
	</tr>
</table>
</form>


</td>
				</tr>

				<tr>
					<td style="background-image: url('images/aidat-ic_08.png'); background-repeat: no-repeat" width="713" height="45">&nbsp;</td>
				</tr>
			</table>
			</td>
				  <td align="center" valign="top"><table border="0" width="206" cellpadding="0" style="border-collapse: collapse">
					  <tr>
					    <td rowspan="2" valign="top" align="left" style="background-image: url('images/aidat-sag_03.png'); background-repeat: no-repeat" width="52" height="117">&nbsp;</td>
					    <td valign="top" align="left" style="background-image: url('images/aidat-sag_04.png'); background-repeat: no-repeat" width="154" height="10"></td>
				      </tr>
					  <tr>
					    <td valign="top" align="left" style="background-image: url('images/aidat-sag_06.png')" width="154" height="107"><span id="sagbaslik">Doping Yap !</span> <br />
					      <span id="sagyazi">
					        <p><span style="font-size: small;"><span style="color: #ff6600; font-s...
				          </span></td>
				      </tr>
					  <tr>
					    <td valign="top" align="left" style="background-image: url('images/aidat-sag_07.png'); background-repeat: no-repeat" width="52" height="40">&nbsp;</td>
					    <td valign="top" align="left" style="background-image: url('images/aidat-sag_08.png')" width="154" height="40">&nbsp;</td>
				      </tr>
					  </table>
					  <table border="0" width="206" cellpadding="0" style="border-collapse: collapse" height="150">
					    <tr>
					      <td rowspan="2" valign="top" align="left" style="background-image: url('images/aidat-sag_11.png'); background-repeat: no-repeat" width="52" height="113">&nbsp;</td>
					      <td valign="top" align="left" style="background-image: url('images/aidat-sag_12.png'); background-repeat: no-repeat" width="154" height="7"></td>
				        </tr>
					    <tr>
					      <td valign="top" align="left" style="background-image: url('images/aidat-sag_13.png')" width="154" height="106"><span id="sagbaslik">Avantajlarımız</span> <br />
					        <span id="sagyazi">
					          <p><span style="font-size: small;"><br /></span></p>
<ul>
<li><span ...
				            </span></td>
				        </tr>
					    <tr>
					      <td valign="top" align="left" style="background-image: url('images/aidat-sag_14.png'); background-repeat: no-repeat" width="52" height="37">&nbsp;</td>
					      <td valign="top" align="left" style="background-image: url('images/aidat-sag_15.png')" width="154" height="37">&nbsp;</td>
				        </tr>
				      </table>
			      <table border="0" width="206" cellpadding="0" style="border-collapse: collapse" height="149">
					    <tr>
					      <td rowspan="2" valign="top" align="left" style="background-image: url('images/aidat-sag_17.png'); background-repeat: no-repeat" width="52" height="112">&nbsp;</td>
					      <td valign="top" align="left" style="background-image: url('images/aidat-sag_18.png'); background-repeat: no-repeat" width="154" height="10"></td>
				        </tr>
					    <tr>
					      <td valign="top" align="left" style="background-image: url('images/aidat-sag_19.png')" width="154" height="102"><span id="sagbaslik">&Uuml;yelik Paketleri</span> <br />
					        <span id="sagyazi">
					          <p>paketler</p>...
				            </span></td>
				        </tr>
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