获取PHP联系表单以通过电子邮件发送姓氏和下拉菜单选项

I have an HTML / PHP form built. It is working and submits successfully on the page stating the form has been submitted.

It emails me some information but I need to include Last Name and the options selected in two drop down menus Program and Start Term.

Any help appreciated. Thanks.

Here's the HTML:

<form class="form" role="form" method="POST" id="phpcontactform">
    <div class="form-group col-md-6" style="padding-left: 0px; padding-right:15px;">
        <input class="form-control input-lg" name="name" id="name" type="text" placeholder="First Name" required>
    </div>
    <div class="form-group col-md-6" style="padding-left: 0px; padding-right:0px;">
        <input class="form-control input-lg" name="lname" id="lname" type="text" placeholder="Last Name" required>
    </div>
    <div class="form-group">
        <input class="form-control input-lg" name="email" id="email" type="email" placeholder="Email" required>
    </div>
    <div class="form-group">
        <input class="form-control input-lg" name="mobile" id="mobile" type="text" placeholder="Phone">
    </div>
    <div class="form-group col-md-6" style="padding-left: 0px; padding-right:15px;">
        <select class="form-control input-lg" id="program" name="program" type="text"> 
            <option value="" selected="selected">Program</option>
            <option value="1" >One Year MBA</option>
            <option value="2" >Part-Time MBA</option>
        </select>
    </div>
    <div class="form-group col-md-6" style="padding-left: 0px; padding-right:0px;">
        <select class="form-control input-lg" id="startterm" name="startterm" type="text"> 
            <option value="" selected="selected">Start Term</option>
            <option value="1" >Fall 2016</option>
            <option value="2" >Spring 2017</option>
            <option value="3" >Summer 2017</option>
            <option value="4" >Fall 2017</option>
        </select>
    </div>
    <div class="form-group col-md-6" style="padding-left: 0px; padding-right:15px;">
        <a href="https://grad.applycanisius.org/login" class="btn btn-warning btn-block btn-lg">Apply Now</a>
    </div>
    <div class="form-group col-md-6 last" style="padding-left: 0px; padding-right:0px;">
        <input type="submit" class="btn btn-warning btn-block btn-lg" value="Submit">
    </div>
</form>

Then the PHP:

<?
    $name = $_REQUEST["name"];
    $lname = $_REQUEST["lname"];
    $email = $_REQUEST["email"];
    $mobile = $_REQUEST["mobile"];
    $program = $_REQUEST["program"];
    $startterm = $_REQUEST["startterm"];
    //$msg   = $_REQUEST["msg"];
    $to = "XXXXX@gmail.com"; // <--- Change email ID here

    if (isset($email) && isset($name)) {
        $subject = "$name sent you a message";
        $headers = "MIME-Version: 1.0" . "
";
        $headers .= "Content-type:text/html;charset=iso-8859-1" . "
";
        $headers .= "From: ".$name." <".$email.">
"."Reply-To: ".$email."
" ;
        $msg     = "From: $name <br /> Last Name: $lname <br/> Email: $email <br/>           

        Phone: $mobile <br /> Program: $program <br /> Start Term: $startterm";     

        //<br/>Message: $msg

        $mail =  mail($to, $subject, $msg, $headers);
        if ($mail) {
            echo 'success';
        } else {
            echo 'failed';
        }
    }
?>

Here is an example of collecting data from a select list:

<?php

$choices = array(
    'foo' => 'big',
    'bar' => 'fat',
    'baz' => 'mamma'
);

if($_SERVER['REQUEST_METHOD'] == 'POST') {
    $choice = isset($_POST['choice']) ? $_POST['choice'] : null;
    $email  = isset($_POST['email'])  ? $_POST['email']  : null;

    if(! array_key_exists($choice, $choices) || filter_var($email, FILTER_VALIDATE_EMAIL) === false)  {
        throw new Exception ("Invalid Choice or email");
    }

    $message = sprintf("User with email: %s, selected: %s.", $email, $choices[$choice]);
    echo $message;
    die;
}

?>

<form method="POST">
    Email:
    <input type="text" name="email">
    Choose:
    <select name='choice'>
        <?php foreach($choices as $k => $v) { ?>
            <option value="<?php echo $k; ?>">
                <?php echo $v ?>
            </option>
        <?php } ?>
    </select>
    <input type="submit">
</form>

first of all, change the html coding for the drop down menu as below

<div class="form-group col-md-6" style="padding-left: 0px; padding-right:15px;">
    <select class="form-control input-lg" id="program" name="program" type="text"> 
        <option value="" selected="selected">Program</option>
        <option value="OneYearMBA" >OneYearMBA</option>
        <option value="Part-TimeMBA" >Part-TimeMBA</option>
    </select>
</div>
<div class="form-group col-md-6" style="padding-left: 0px; padding-right:0px;">
    <select class="form-control input-lg" id="startterm" name="startterm" type="text"> 
        <option value="" selected="selected">Start Term</option>
        <option value="Fall2016" >Fall2016</option>
        <option value="Spring2017" >Spring2017</option>
        <option value="Summer2017" >Summer2017</option>
        <option value="Fall2017" >Fall2017</option>
    </select>
</div>

I guess you want program and start term to be text values instead of numbers. Then it is not advised to leave spaces in the options(the value to be printed on page). Then one more thing in your html put action="phppage.php". then retrieve the values in your php page as $_POST['fieldname'].