{% load i18n %}

<div class="feedback_block">
  <form action="" onsubmit="return false;">
    <fieldset class="feedback_likert_field">
      <legend class="feedback_likert_header">{{likert_prompt}}</legend>
      <div class="feedback_likert_scale">{{scale|safe}}</div>
    </fieldset>

    <div class="feedback_header_div">
      <label class="feedback_header" for="feedback_freeform_textarea">{{freeform_prompt}}</label>
    </div>
    <div class="feedback_freeform_input">
      <textarea name="feedback_freeform_textarea" class="feedback_freeform_area" rows="6" cols="45" placeholder="{{placeholder}}">{{self.user_freeform}}</textarea>
      <div class="feedback_thank_you" aria-live=polite>{{response}}</div>
    </div>
    <button type="submit" class="feedback_submit_feedback">{% trans "Submit Feedback" %}</button>
  </form>
</div>