Save the given code in new file with name as admissionInfo.php . This given code is used to submit the overall details of a student in database for approval by the admin of the institution.
$pc = $_POST['Program'];
$RC= $_POST['RCNAME'];
global $stts,$nm,$eml,$unm,$cp,$p,$ct,$stt,$usnm,$emls,$val;
if(isset($_POST['save']))
{
registeration();
}
?>
<!DOCTYPE html PUBLIC "-//W3C//DTD XHTML 1.0 Strict//EN" "http://www.w3.org/TR/xhtml1/DTD/xhtml1-strict.dtd">
<html xmlns="http://www.w3.org/1999/xhtml" xml:lang="en-US" lang="en-US">
<head>
<title>Welcome To Online Admission</title>
<link rel="STYLESHEET" type="text/css" href="styles/admission_form.css" />
<link rel="STYLESHEET" type="text/css" href="styles/style.css" />
<script LANGUAGE="JavaScript">
function ValidateForm()
{
if(document.admission_form.SCCode1.value=="select" || document.admission_form.SCCode2.value=="select" || document.admission_form.SCCode3.value=="select" || document.admission_form.SStateCode.value=="select" || document.admission_form.Medium.value=="select" || document.admission_form.registered.value=="select" || document.admission_form.stuname.value =="" || document.admission_form.relation.value=="select" || document.admission_form.fname.value=="" || document.admission_form.date.value=="select" || document.admission_form.month.value=="select" || document.admission_form.year.value=="select" || document.admission_form.nationalty.value=="select" || document.admission_form.gender.value=="select" || document.admission_form.category.value=="select" || document.admission_form.territory.value=="select" || document.admission_form.mstatus.value=="select" || document.admission_form.religion.value=="select" || document.admission_form.minority.value=="select" || document.admission_form.socialsts.value=="select" || document.admission_form.migrant.value=="select" || document.admission_form.empstats.value=="select" || document.admission_form.amount.value =="" || document.admission_form.mainsub.value == "" || document.admission_form.yearpass.value =="" || document.admission_form.division.value=="select" || document.admission_form.percentage.value =="" || document.admission_form.Board_code.value=="select" || document.admission_form.DDAmt.value == "" || document.admission_form.BnkDNo.value == "" || document.admission_form.BnkDDate.value || document.admission_form.placeissue.value == "" || document.admission_form.payat.value == "" || document.admission_form.corspdns.value == "" || document.admission_form.add2.value == "" || document.admission_form.add3.value == "" || document.admission_form.city.value == "" || document.admission_form.LStateCode.value=="select" || document.admission_form.pincode.value == "" || document.admission_form.mobileno.value == "" || document.admission_form.emailid.value== "" || document.admission_form.marksheetCertificate.value == "" || document.admission_form.degreecertificate.value== "" || document.admission_form.dobc.value == "" || document.admission_form.ddcopy.value == "" )
{
alert("Fields marked with * are mandatory");
return false;
}
//if(document.admission_form.relation.value=="select" || document.admission_form.fname.value=="" || document.admission_form.date.value=="select" || document.admission_form.month.value=="select" || document.admission_form.year.value=="select" || document.admission_form.nationalty.value=="select" || document.admission_form.gender.value=="select" || document.admission_form.category.value=="select" || document.admission_form.territory.value=="select" || document.admission_form.mstatus.value=="select" || document.admission_form.religion.value=="select" || document.admission_form.minority.value=="select" || document.admission_form.socialsts.value=="select" || document.admission_form.migrant.value=="select" || document.admission_form.empstats.value=="select" || document.admission_form.amount.value =="" || document.admission_form.mainsub.value == "" || document.admission_form.yearpass.value =="" || document.admission_form.division.value=="select" || document.admission_form.percentage.value =="" || document.admission_form.Board_code.value=="select" || document.admission_form.DDAmt.value == "" || document.admission_form.BnkDNo.value == "" || document.admission_form.BnkDDate.value || document.admission_form.placeissue.value == "" || document.admission_form.payat.value == "" || document.admission_form.corspdns.value == "" || document.admission_form.add2.value == "" || document.admission_form.add3.value == "" || document.admission_form.city.value == "" || document.admission_form.LStateCode.value=="select" || document.admission_form.pincode.value == "" || document.admission_form.mobileno.value == "" || document.admission_form.emailid.value== "" || document.admission_form.marksheetCertificate.value == "" || document.admission_form.degreecertificate.value== "" || document.admission_form.dobc.value == "" || document.admission_form.ddcopy.value == "" )
/*if(document.admission_form.enrolmentno.value=="")
{
alert ( "You must fill your enrolment number" );
return false;
}*/
if(document.admission_form.registered.value== "y")
{
if(document.admission_form.enrolmentno.value=="")
{
alert ( "You must fill your enrolment number" );
return false;
}
if(document.admission_form.pcode.value=="select")
{
alert ( "You must select your programm code you have registered before" );
return false;
}
}
if(document.admission_form.phandicap.value=="phyes")
{
alert("You must specify nature of disablitity");
}
if(document.admission_form.i_agree.checked == false)
{
alert ( "You must agree with our term & conditions" );
return false;
}
return true;
}
</script>
</head>
<body >
<?php include("header.php"); ?>
<center>
<div class='mainDiv' style="background:#DCDCDC;">
<div><font size="5" name="sans-serif" color="white"><div class="heading" style="border-radius: 10px;" align="center"><b>Welcome To Distance Education University Online Admission Form</b></div></font>
<font size="3" name="sans-serif"><div align="center">APPLICATION FORM (Admissions - Jul-2013) </div><div align="center">Fields marked with * are mandatory. </div></font></br>
</br></br>
<form name='admission_form' id='admission_form' method='post' enctype="multipart/form-data">
<div align="left" style="width: 810px;">
<samp class='labels'>Program Code Selected</samp>
<span>:</span>
<pre><?php echo $pc; ?></pre>
<input type="hidden" name="Program" value="<?php echo $pc;?>">
<br/>
<samp class='labels'>Regional Centre Code:Name</samp>
<span> : </span>
<pre ><?php echo $RC; ?></pre>
<input type="hidden" name="RCNAME" value="<?php echo $RC;?>">
<br/>
<div class='labels' >      SC Code (Select 0000-To Be alloted by RC, whereever required)</div>
<br/>
<label>*</label>
<kbd class='labels'>Choice 1</kbd>
<SELECT name="SCCode1">
<option value="select" >Select</option>
<?php getStudyCenter($_POST['RCNAME']); ?>
</select>
<br/>
<label>*</label>
<kbd class='labels'>Choice 2</kbd>
<SELECT class=textbox name="SCCode2">
<option value="select">Select</option>
<?php getStudyCenter($_POST['RCNAME']); ?>
</select>
<br/>
<label>*</label>
<kbd class='labels'>Choice 3</kbd>
<select class=textbox name="SCCode3">
<option value="select">Select</option>
<?php getStudyCenter($_POST['RCNAME']); ?>
</select>
<br/>
<label>*</label>
<samp class='labels'>State Code where your Regional Centre is located</samp>
<span> : </span>
<SELECT name="SStateCode">
<option value='select'>--Select--</option>
<?php regionalcentre();?>
</SELECT>
<br/>
<label>*</label>
<samp class='labels'>Medium</samp>
<span> : </span>
<select NAME="Medium" >
<option value='select'>--Select--</option>
<option value='ENGLISH'>ENGLISH</option>
<option value='HINDI'>HINDI</option>
</select>
<br/>
<label>*</label>
<samp class='labels'>Are you already registered us?</samp>
<span> : </span>
<select name="registered" >
<option value="select">--select--</option>
<option value="Yes">Yes</option>
<option value="No">No</option>
</select>
<br/>
<samp class='labels'>If yes write the Enrollment No. & Program Code </samp>
<span> : </span>
<input class='smallinput' type="text" name="enrolmentno" size=9 maxlength=9>
<select name="pcode">
<?php programscode(); ?>
</select>
<pre><?php $eno;?></pre>
<br/><br/>
<div align="center">Personal/General Detail</div>
<br/>
<label>*</label>
<samp class='labels'>Name</samp>
<span> : </span>
<input type="text" name="stuname">
<br/>
<label>*</label>
<samp class='labels'>Name of Father/Husband/Mother</samp>
<span> : </span>
<select name="relation">
<option value="select">select</option>
<option value="Father">Father</option>
<option value="Mother">Mother</option>
<option value="Husband">Husband</option>
</select>
<input type="text" name="fname">
<br/>
<label>*</label>
<samp class='labels'>Date of Birth</samp>
<span> : </span>
<select name="date">
<?php dateBox();?>
</select>
<select name="month">
<?php monthBox();?>
</select>
<select name="year">
<?php yearBox();?>
</select>
<br/>
<label>*</label>
<samp class='labels'>Nationality</samp>
<span> : </span>
<select name="nationalty">
<option value="select">Select</option>
<option value="Indian">Indian</option>
</select>
<br/>
<label>*</label>
<samp class='labels'>Sex</samp>
<span> : </span>
<select name="gender">
<option value="select">select</option>
<option value="Male">Male</option>
<option value="Female">Female</option>
</select>
<br/>
<label>*</label>
<samp class='labels'>Category</samp>
<span> : </span>
<select name="category">
<option value="select">select</option>
<option value="General">General</option>
<option value="SC">SC</option>
<option value="ST">ST</option>
<option value="cOBC-Creamy Layer">OBC-Creamy Layer</option>
<option value="OBC-Non Creamy Layer">OBC-Non Creamy Layer</option>
</select>
<br/>
<label>*</label>
<samp class='labels'>Territory</samp>
<span> : </span>
<select name="territory">
<option value="select">select</option>
<option value="Urban">Urban</option>
<option value="Rural">Rural</option>
<option value="Tribal">Tribal</option>
</select>
<br/>
<label>*</label>
<samp class='labels'>Marital Status</samp>
<span> : </span>
<select name="mstatus">
<option value="select">select</option>
<option value="Married">Married</option>
<option value="Unmarried">Unmarried</option>
</select>
<br/>
<label>*</label>
<samp class='labels'>Religion</samp>
<span> : </span>
<select name="religion">
<option value="select">select</option>
<option value="Hindu">Hindu</option>
<option value="Muslim">Muslim</option>
<option value="Christian">Christian</option>
<option value="Sikh">Sikh</option>
<option value="Jain">Jain</option>
<option value="Buddhist">Buddhist</option>
<option value="Parsii">Parsi</option>
<option value="Jew">Jew</option>
<option value="Other">Other</option>
</select>
<br/>
<label>*</label>
<samp class='labels'>Whether Minority</samp>
<span> : </span>
<select name="minority">
<option value="select">select</option>
<option value="Yes">Yes</option>
<option value="No">No</option>
</select>
<br/>
<label>*</label>
<samp class='labels'>Social Status</samp>
<span> : </span>
<select name="socialsts">
<option value="select">select</option>
<option value="Not Applicable">Not Applicable</option>
<option value="Ex-Service Man">Ex-Service Man</option>
<option value="War widow">War widow</option>
</select>
<br/>
<label>*</label>
<samp class='labels'>Whether Kashmiri Migrant</samp>
<span> : </span>
<select name="migrant">
<option value="select">select</option>
<option value="Yes">Yes</option>
<option value="No">No</option>
</select>
<br/><br/>
<div align="center">Other Details</div>
<br/>
<label>*</label>
<samp class='labels'>Whether Physically handicapped(PH)</samp>
<span> : </span>
<select name="phandicap">
<option value="select">select</option>
<option value="Yes">Yes</option>
<option value="No">No</option>
</select>
<br/>
<samp class='labels'>If physically handicapped (nature of disablitity) </samp>
<span> : </span>
<select name="handicap">
<option value="select">select</option>
<option value="Hearing Impairement">Hearing Impairement</option>
<option value="Locomotor Impairement">Locomotor Impairement</option>
<option value="Visual Impairement">Visual Impairement</option>
<option value="Reading Disability">Reading Disability</option>
<option value="Any other">Any other</option>
</select>
<br/>
<samp class='labels'>Other Specify</samp>
<span> : </span>
<input type="text" name="otherhandicap">
<br/>
<label>*</label>
<samp class='labels'>Employment Status</samp>
<span> : </span>
<select name="empstats">
<option value="select">select</option>
<option value="Unemployed">Unemployed</option>
<option value="Employed">Employed</option>
</select>
<br/>
<br/>
<div align="center">Relevant Education (Which makes you eligible for Programme) </div>
<br/>
<label>*</label>
<samp class='labels'>Main Subjects (in short form)</samp>
<span> : </span>
<input type="text" name="mainsub">
<br/>
<label>*</label>
<samp class='labels'>Year of Passing</samp>
<span> : </span>
<input type="text" name="yearpass">
<br/>
<label>*</label>
<samp class='labels'>Division</samp>
<span> : </span>
<select name="division">
<option value="select">Select</option>
<option value="I">I</option>
<option value="II">II</option>
<option value="III">III</option>
<option value="IV(For Pass)">IV(For Pass)</option>
</select>
<br/>
<label>*</label>
<samp class='labels'>% of Marks</samp>
<span> : </span>
<input type="text" name="percentage">
<br/>
<label>*</label>
<samp class='labels'>Board Code(whether required)</samp>
<span> : </span>
<SELECT name="Board_code" class="textbox">
<option value=''>--Select--</option>
<option value='ABIE'>0101:ABIE</option>
<option value='AHSL'>0401:AHSL</option>
<option value='BIEC'>0501:BIEC</option>
<option value='CBSE'>0701:CBSE</option>
<option value='ICSE'>0702:ICSE</option>
<option value='NOS/NIOS'>0703:NOS/NIOS</option>
<option value='GBSE'>0801:GBSE</option>
<option value='GSEB'>0901:GSEB</option>
<option value='HBSE'>1001:HBSE</option>
<option value='HPBE'>1101:HPBE</option>
<option value='JKSS'>1201:JKSS</option>
<option value='JKSW'>1202:JKSW</option>
<option value='KBPE'>1301:KBPE</option>
<option value='KU'>1401:KU</option>
<option value='BSMP'>1501:BSMP</option>
<option value='MSBE'>1601:MSBE</option>
<option value='MBSE'>1701:MBSE</option>
<option value='MZSE'>1901:MZSE</option>
<option value='NBSE'>2001:NBSE</option>
<option value='CHSE'>2101:CHSE</option>
<option value='PSEB'>2201:PSEB</option>
<option value='RBSE'>2301:RBSE</option>
<option value='TNSB'>2501:TNSB</option>
<option value='TBSE'>2601:TBSE</option>
<option value='BHSI'>2701:BHSI</option>
<option value='WBSE'>2802:WBSE</option>
<option value='JAC'>3601:JAC</option>
<option value='DDDD'>8888:DDDD</option>
</SELECT>
<br/><br/>
<div align="center">Payment Gateway Selection</div>
<br/>
<label>*</label>
<samp class='labels'>Name of the Bank</samp>
<span> : </span>
<select name="BankName">
<?php echo bankname();?>
</select>
<br/>
<label>*</label>
<samp class='labels'>Draft Amount</samp>
<span>:</span>
<input type="text" name="DDAmt">
<br/>
<label>*</label>
<samp class='labels'>Bank Draft No.</samp>
<span>:</span>
<input type="text" name="BnkDNo">
<br/>
<label>*</label>
<samp class='labels'>Bank Draft Date</samp>
<span>:</span>
<input type="text" name="BnkDDate"><label>Ex: 1980-02-15</label>
<br/>
<label>*</label>
<samp class='labels'>Place of Issue</samp>
<span>:</span>
<input type="text" name="placeissue">
<br/>
<label>*</label>
<samp class='labels'>Payable At</samp>
<span>:</span>
<input type="text" name="payat">
<br/><br/>
<div align="center">Correspondence Details</div>
<br/>
<label>*</label>
<samp class='labels'>Correspodence Address Line 1</samp>
<span> : </span>
<input type="text" name="corspdns">
<br/>
<label>*</label>
<samp class='labels'>Address Line 2</samp>
<span> : </span>
<input type="text" name="add2">
<br/>
<label>*</label>
<samp class='labels'>Address Line 3</samp>
<span> : </span>
<input type="text" name="add3">
<br/>
<label>*</label>
<samp class='labels'>City</samp>
<span> : </span>
<input type="text" name="city">
<br/>
<label>*</label>
<samp class='labels'>State</samp>
<span> : </span>
<SELECT name="LStateCode">
<?php state();?>
</SELECT>
<br/>
<label>*</label>
<samp class='labels'>Pin Code</samp>
<span> : </span>
<input type="text" name="pincode">
<br/>
<label> </label>
<samp class='labels'>Telephone No. (if any) with STD Code</samp>
<span> : </span>
<input type="text" name="telephone">
<br/>
<label>*</label>
<samp class='labels'>Mobile No. (if any)</samp>
<span> : </span>
<input type="text" name="mobileno">
<br/>
<label>*</label>
<samp class='labels'>Email-ID(if any, should be valid for 6 months)</samp>
<span> : </span>
<input type="text" name="emailid">
<br/>
<label>*</label>
<samp class='labels'>Certificate Date of Birth</samp>
<span> : </span>
<input type="file" name="dobc">
<br/>
<label>*</label>
<samp class='labels'>Qualified Degree OR School Certificate</samp>
<span> : </span>
<input type="file" name="degreecertificate">
<br/>
<label>*</label>
<samp class='labels'>Qualified Degree OR SchoolMarksheet</samp>
<span> : </span>
<input type="file" name="marksheetCertificate">
<br/>
<label>*</label>
<samp class='labels'>Scanned Copy Of Demand Draft</samp>
<span> : </span>
<input type="file" name="ddcopy">
<br/>
<br/>
<div class="labels" style="border:1px solid #aaa;font-family : sans-serif;" align="center"><b>Declaration</b><br/>
<div align="justify"> I hereby declare that I have read and understood the conditions of eligibility for the programme for which I seek admission. I fulfil the minimum eligibility criteria and I have provided necessary information in this regard. In the event of any information being found incorrect or misleading, my candidature shall be liable to cancellation by the University at any time and I shall not be entitled to refund of any fee paid by me to the University. I have carefully studied the rules of the University as printed in the Prospectus and I accept them and shall not raise any dispute in future over the same rules. Further, I also understand that it will be University discretion to allot a study centre. </div>
</div> </div>
<br/>
<samp> </samp><label>*</label><input type="checkbox" name="i_agree" value="1"><pre>I agree to the terms & conditions</pre>
<br />
<div align="center"><input type="submit" name="save" value="Submit" onclick="return ValidateForm();"></div>
<br />
</form>
</div>
<?php include("footer.php"); ?>
</body>
</html>
<?php
include("functions.php");$pc = $_POST['Program'];
$RC= $_POST['RCNAME'];
global $stts,$nm,$eml,$unm,$cp,$p,$ct,$stt,$usnm,$emls,$val;
if(isset($_POST['save']))
{
registeration();
}
?>
<!DOCTYPE html PUBLIC "-//W3C//DTD XHTML 1.0 Strict//EN" "http://www.w3.org/TR/xhtml1/DTD/xhtml1-strict.dtd">
<html xmlns="http://www.w3.org/1999/xhtml" xml:lang="en-US" lang="en-US">
<head>
<title>Welcome To Online Admission</title>
<link rel="STYLESHEET" type="text/css" href="styles/admission_form.css" />
<link rel="STYLESHEET" type="text/css" href="styles/style.css" />
<script LANGUAGE="JavaScript">
function ValidateForm()
{
if(document.admission_form.SCCode1.value=="select" || document.admission_form.SCCode2.value=="select" || document.admission_form.SCCode3.value=="select" || document.admission_form.SStateCode.value=="select" || document.admission_form.Medium.value=="select" || document.admission_form.registered.value=="select" || document.admission_form.stuname.value =="" || document.admission_form.relation.value=="select" || document.admission_form.fname.value=="" || document.admission_form.date.value=="select" || document.admission_form.month.value=="select" || document.admission_form.year.value=="select" || document.admission_form.nationalty.value=="select" || document.admission_form.gender.value=="select" || document.admission_form.category.value=="select" || document.admission_form.territory.value=="select" || document.admission_form.mstatus.value=="select" || document.admission_form.religion.value=="select" || document.admission_form.minority.value=="select" || document.admission_form.socialsts.value=="select" || document.admission_form.migrant.value=="select" || document.admission_form.empstats.value=="select" || document.admission_form.amount.value =="" || document.admission_form.mainsub.value == "" || document.admission_form.yearpass.value =="" || document.admission_form.division.value=="select" || document.admission_form.percentage.value =="" || document.admission_form.Board_code.value=="select" || document.admission_form.DDAmt.value == "" || document.admission_form.BnkDNo.value == "" || document.admission_form.BnkDDate.value || document.admission_form.placeissue.value == "" || document.admission_form.payat.value == "" || document.admission_form.corspdns.value == "" || document.admission_form.add2.value == "" || document.admission_form.add3.value == "" || document.admission_form.city.value == "" || document.admission_form.LStateCode.value=="select" || document.admission_form.pincode.value == "" || document.admission_form.mobileno.value == "" || document.admission_form.emailid.value== "" || document.admission_form.marksheetCertificate.value == "" || document.admission_form.degreecertificate.value== "" || document.admission_form.dobc.value == "" || document.admission_form.ddcopy.value == "" )
{
alert("Fields marked with * are mandatory");
return false;
}
//if(document.admission_form.relation.value=="select" || document.admission_form.fname.value=="" || document.admission_form.date.value=="select" || document.admission_form.month.value=="select" || document.admission_form.year.value=="select" || document.admission_form.nationalty.value=="select" || document.admission_form.gender.value=="select" || document.admission_form.category.value=="select" || document.admission_form.territory.value=="select" || document.admission_form.mstatus.value=="select" || document.admission_form.religion.value=="select" || document.admission_form.minority.value=="select" || document.admission_form.socialsts.value=="select" || document.admission_form.migrant.value=="select" || document.admission_form.empstats.value=="select" || document.admission_form.amount.value =="" || document.admission_form.mainsub.value == "" || document.admission_form.yearpass.value =="" || document.admission_form.division.value=="select" || document.admission_form.percentage.value =="" || document.admission_form.Board_code.value=="select" || document.admission_form.DDAmt.value == "" || document.admission_form.BnkDNo.value == "" || document.admission_form.BnkDDate.value || document.admission_form.placeissue.value == "" || document.admission_form.payat.value == "" || document.admission_form.corspdns.value == "" || document.admission_form.add2.value == "" || document.admission_form.add3.value == "" || document.admission_form.city.value == "" || document.admission_form.LStateCode.value=="select" || document.admission_form.pincode.value == "" || document.admission_form.mobileno.value == "" || document.admission_form.emailid.value== "" || document.admission_form.marksheetCertificate.value == "" || document.admission_form.degreecertificate.value== "" || document.admission_form.dobc.value == "" || document.admission_form.ddcopy.value == "" )
/*if(document.admission_form.enrolmentno.value=="")
{
alert ( "You must fill your enrolment number" );
return false;
}*/
if(document.admission_form.registered.value== "y")
{
if(document.admission_form.enrolmentno.value=="")
{
alert ( "You must fill your enrolment number" );
return false;
}
if(document.admission_form.pcode.value=="select")
{
alert ( "You must select your programm code you have registered before" );
return false;
}
}
if(document.admission_form.phandicap.value=="phyes")
{
alert("You must specify nature of disablitity");
}
if(document.admission_form.i_agree.checked == false)
{
alert ( "You must agree with our term & conditions" );
return false;
}
return true;
}
</script>
</head>
<body >
<?php include("header.php"); ?>
<center>
<div class='mainDiv' style="background:#DCDCDC;">
<div><font size="5" name="sans-serif" color="white"><div class="heading" style="border-radius: 10px;" align="center"><b>Welcome To Distance Education University Online Admission Form</b></div></font>
<font size="3" name="sans-serif"><div align="center">APPLICATION FORM (Admissions - Jul-2013) </div><div align="center">Fields marked with * are mandatory. </div></font></br>
</br></br>
<form name='admission_form' id='admission_form' method='post' enctype="multipart/form-data">
<div align="left" style="width: 810px;">
<samp class='labels'>Program Code Selected</samp>
<span>:</span>
<pre><?php echo $pc; ?></pre>
<input type="hidden" name="Program" value="<?php echo $pc;?>">
<br/>
<samp class='labels'>Regional Centre Code:Name</samp>
<span> : </span>
<pre ><?php echo $RC; ?></pre>
<input type="hidden" name="RCNAME" value="<?php echo $RC;?>">
<br/>
<div class='labels' >      SC Code (Select 0000-To Be alloted by RC, whereever required)</div>
<br/>
<label>*</label>
<kbd class='labels'>Choice 1</kbd>
<SELECT name="SCCode1">
<option value="select" >Select</option>
<?php getStudyCenter($_POST['RCNAME']); ?>
</select>
<br/>
<label>*</label>
<kbd class='labels'>Choice 2</kbd>
<SELECT class=textbox name="SCCode2">
<option value="select">Select</option>
<?php getStudyCenter($_POST['RCNAME']); ?>
</select>
<br/>
<label>*</label>
<kbd class='labels'>Choice 3</kbd>
<select class=textbox name="SCCode3">
<option value="select">Select</option>
<?php getStudyCenter($_POST['RCNAME']); ?>
</select>
<br/>
<label>*</label>
<samp class='labels'>State Code where your Regional Centre is located</samp>
<span> : </span>
<SELECT name="SStateCode">
<option value='select'>--Select--</option>
<?php regionalcentre();?>
</SELECT>
<br/>
<label>*</label>
<samp class='labels'>Medium</samp>
<span> : </span>
<select NAME="Medium" >
<option value='select'>--Select--</option>
<option value='ENGLISH'>ENGLISH</option>
<option value='HINDI'>HINDI</option>
</select>
<br/>
<label>*</label>
<samp class='labels'>Are you already registered us?</samp>
<span> : </span>
<select name="registered" >
<option value="select">--select--</option>
<option value="Yes">Yes</option>
<option value="No">No</option>
</select>
<br/>
<samp class='labels'>If yes write the Enrollment No. & Program Code </samp>
<span> : </span>
<input class='smallinput' type="text" name="enrolmentno" size=9 maxlength=9>
<select name="pcode">
<?php programscode(); ?>
</select>
<pre><?php $eno;?></pre>
<br/><br/>
<div align="center">Personal/General Detail</div>
<br/>
<label>*</label>
<samp class='labels'>Name</samp>
<span> : </span>
<input type="text" name="stuname">
<br/>
<label>*</label>
<samp class='labels'>Name of Father/Husband/Mother</samp>
<span> : </span>
<select name="relation">
<option value="select">select</option>
<option value="Father">Father</option>
<option value="Mother">Mother</option>
<option value="Husband">Husband</option>
</select>
<input type="text" name="fname">
<br/>
<label>*</label>
<samp class='labels'>Date of Birth</samp>
<span> : </span>
<select name="date">
<?php dateBox();?>
</select>
<select name="month">
<?php monthBox();?>
</select>
<select name="year">
<?php yearBox();?>
</select>
<br/>
<label>*</label>
<samp class='labels'>Nationality</samp>
<span> : </span>
<select name="nationalty">
<option value="select">Select</option>
<option value="Indian">Indian</option>
</select>
<br/>
<label>*</label>
<samp class='labels'>Sex</samp>
<span> : </span>
<select name="gender">
<option value="select">select</option>
<option value="Male">Male</option>
<option value="Female">Female</option>
</select>
<br/>
<label>*</label>
<samp class='labels'>Category</samp>
<span> : </span>
<select name="category">
<option value="select">select</option>
<option value="General">General</option>
<option value="SC">SC</option>
<option value="ST">ST</option>
<option value="cOBC-Creamy Layer">OBC-Creamy Layer</option>
<option value="OBC-Non Creamy Layer">OBC-Non Creamy Layer</option>
</select>
<br/>
<label>*</label>
<samp class='labels'>Territory</samp>
<span> : </span>
<select name="territory">
<option value="select">select</option>
<option value="Urban">Urban</option>
<option value="Rural">Rural</option>
<option value="Tribal">Tribal</option>
</select>
<br/>
<label>*</label>
<samp class='labels'>Marital Status</samp>
<span> : </span>
<select name="mstatus">
<option value="select">select</option>
<option value="Married">Married</option>
<option value="Unmarried">Unmarried</option>
</select>
<br/>
<label>*</label>
<samp class='labels'>Religion</samp>
<span> : </span>
<select name="religion">
<option value="select">select</option>
<option value="Hindu">Hindu</option>
<option value="Muslim">Muslim</option>
<option value="Christian">Christian</option>
<option value="Sikh">Sikh</option>
<option value="Jain">Jain</option>
<option value="Buddhist">Buddhist</option>
<option value="Parsii">Parsi</option>
<option value="Jew">Jew</option>
<option value="Other">Other</option>
</select>
<br/>
<label>*</label>
<samp class='labels'>Whether Minority</samp>
<span> : </span>
<select name="minority">
<option value="select">select</option>
<option value="Yes">Yes</option>
<option value="No">No</option>
</select>
<br/>
<label>*</label>
<samp class='labels'>Social Status</samp>
<span> : </span>
<select name="socialsts">
<option value="select">select</option>
<option value="Not Applicable">Not Applicable</option>
<option value="Ex-Service Man">Ex-Service Man</option>
<option value="War widow">War widow</option>
</select>
<br/>
<label>*</label>
<samp class='labels'>Whether Kashmiri Migrant</samp>
<span> : </span>
<select name="migrant">
<option value="select">select</option>
<option value="Yes">Yes</option>
<option value="No">No</option>
</select>
<br/><br/>
<div align="center">Other Details</div>
<br/>
<label>*</label>
<samp class='labels'>Whether Physically handicapped(PH)</samp>
<span> : </span>
<select name="phandicap">
<option value="select">select</option>
<option value="Yes">Yes</option>
<option value="No">No</option>
</select>
<br/>
<samp class='labels'>If physically handicapped (nature of disablitity) </samp>
<span> : </span>
<select name="handicap">
<option value="select">select</option>
<option value="Hearing Impairement">Hearing Impairement</option>
<option value="Locomotor Impairement">Locomotor Impairement</option>
<option value="Visual Impairement">Visual Impairement</option>
<option value="Reading Disability">Reading Disability</option>
<option value="Any other">Any other</option>
</select>
<br/>
<samp class='labels'>Other Specify</samp>
<span> : </span>
<input type="text" name="otherhandicap">
<br/>
<label>*</label>
<samp class='labels'>Employment Status</samp>
<span> : </span>
<select name="empstats">
<option value="select">select</option>
<option value="Unemployed">Unemployed</option>
<option value="Employed">Employed</option>
</select>
<br/>
<br/>
<div align="center">Relevant Education (Which makes you eligible for Programme) </div>
<br/>
<label>*</label>
<samp class='labels'>Main Subjects (in short form)</samp>
<span> : </span>
<input type="text" name="mainsub">
<br/>
<label>*</label>
<samp class='labels'>Year of Passing</samp>
<span> : </span>
<input type="text" name="yearpass">
<br/>
<label>*</label>
<samp class='labels'>Division</samp>
<span> : </span>
<select name="division">
<option value="select">Select</option>
<option value="I">I</option>
<option value="II">II</option>
<option value="III">III</option>
<option value="IV(For Pass)">IV(For Pass)</option>
</select>
<br/>
<label>*</label>
<samp class='labels'>% of Marks</samp>
<span> : </span>
<input type="text" name="percentage">
<br/>
<label>*</label>
<samp class='labels'>Board Code(whether required)</samp>
<span> : </span>
<SELECT name="Board_code" class="textbox">
<option value=''>--Select--</option>
<option value='ABIE'>0101:ABIE</option>
<option value='AHSL'>0401:AHSL</option>
<option value='BIEC'>0501:BIEC</option>
<option value='CBSE'>0701:CBSE</option>
<option value='ICSE'>0702:ICSE</option>
<option value='NOS/NIOS'>0703:NOS/NIOS</option>
<option value='GBSE'>0801:GBSE</option>
<option value='GSEB'>0901:GSEB</option>
<option value='HBSE'>1001:HBSE</option>
<option value='HPBE'>1101:HPBE</option>
<option value='JKSS'>1201:JKSS</option>
<option value='JKSW'>1202:JKSW</option>
<option value='KBPE'>1301:KBPE</option>
<option value='KU'>1401:KU</option>
<option value='BSMP'>1501:BSMP</option>
<option value='MSBE'>1601:MSBE</option>
<option value='MBSE'>1701:MBSE</option>
<option value='MZSE'>1901:MZSE</option>
<option value='NBSE'>2001:NBSE</option>
<option value='CHSE'>2101:CHSE</option>
<option value='PSEB'>2201:PSEB</option>
<option value='RBSE'>2301:RBSE</option>
<option value='TNSB'>2501:TNSB</option>
<option value='TBSE'>2601:TBSE</option>
<option value='BHSI'>2701:BHSI</option>
<option value='WBSE'>2802:WBSE</option>
<option value='JAC'>3601:JAC</option>
<option value='DDDD'>8888:DDDD</option>
</SELECT>
<br/><br/>
<div align="center">Payment Gateway Selection</div>
<br/>
<label>*</label>
<samp class='labels'>Name of the Bank</samp>
<span> : </span>
<select name="BankName">
<?php echo bankname();?>
</select>
<br/>
<label>*</label>
<samp class='labels'>Draft Amount</samp>
<span>:</span>
<input type="text" name="DDAmt">
<br/>
<label>*</label>
<samp class='labels'>Bank Draft No.</samp>
<span>:</span>
<input type="text" name="BnkDNo">
<br/>
<label>*</label>
<samp class='labels'>Bank Draft Date</samp>
<span>:</span>
<input type="text" name="BnkDDate"><label>Ex: 1980-02-15</label>
<br/>
<label>*</label>
<samp class='labels'>Place of Issue</samp>
<span>:</span>
<input type="text" name="placeissue">
<br/>
<label>*</label>
<samp class='labels'>Payable At</samp>
<span>:</span>
<input type="text" name="payat">
<br/><br/>
<div align="center">Correspondence Details</div>
<br/>
<label>*</label>
<samp class='labels'>Correspodence Address Line 1</samp>
<span> : </span>
<input type="text" name="corspdns">
<br/>
<label>*</label>
<samp class='labels'>Address Line 2</samp>
<span> : </span>
<input type="text" name="add2">
<br/>
<label>*</label>
<samp class='labels'>Address Line 3</samp>
<span> : </span>
<input type="text" name="add3">
<br/>
<label>*</label>
<samp class='labels'>City</samp>
<span> : </span>
<input type="text" name="city">
<br/>
<label>*</label>
<samp class='labels'>State</samp>
<span> : </span>
<SELECT name="LStateCode">
<?php state();?>
</SELECT>
<br/>
<label>*</label>
<samp class='labels'>Pin Code</samp>
<span> : </span>
<input type="text" name="pincode">
<br/>
<label> </label>
<samp class='labels'>Telephone No. (if any) with STD Code</samp>
<span> : </span>
<input type="text" name="telephone">
<br/>
<label>*</label>
<samp class='labels'>Mobile No. (if any)</samp>
<span> : </span>
<input type="text" name="mobileno">
<br/>
<label>*</label>
<samp class='labels'>Email-ID(if any, should be valid for 6 months)</samp>
<span> : </span>
<input type="text" name="emailid">
<br/>
<label>*</label>
<samp class='labels'>Certificate Date of Birth</samp>
<span> : </span>
<input type="file" name="dobc">
<br/>
<label>*</label>
<samp class='labels'>Qualified Degree OR School Certificate</samp>
<span> : </span>
<input type="file" name="degreecertificate">
<br/>
<label>*</label>
<samp class='labels'>Qualified Degree OR SchoolMarksheet</samp>
<span> : </span>
<input type="file" name="marksheetCertificate">
<br/>
<label>*</label>
<samp class='labels'>Scanned Copy Of Demand Draft</samp>
<span> : </span>
<input type="file" name="ddcopy">
<br/>
<br/>
<div class="labels" style="border:1px solid #aaa;font-family : sans-serif;" align="center"><b>Declaration</b><br/>
<div align="justify"> I hereby declare that I have read and understood the conditions of eligibility for the programme for which I seek admission. I fulfil the minimum eligibility criteria and I have provided necessary information in this regard. In the event of any information being found incorrect or misleading, my candidature shall be liable to cancellation by the University at any time and I shall not be entitled to refund of any fee paid by me to the University. I have carefully studied the rules of the University as printed in the Prospectus and I accept them and shall not raise any dispute in future over the same rules. Further, I also understand that it will be University discretion to allot a study centre. </div>
</div> </div>
<br/>
<samp> </samp><label>*</label><input type="checkbox" name="i_agree" value="1"><pre>I agree to the terms & conditions</pre>
<br />
<div align="center"><input type="submit" name="save" value="Submit" onclick="return ValidateForm();"></div>
<br />
</form>
</div>
<?php include("footer.php"); ?>
</body>
</html>
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