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index.php
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<!DOCTYPE html>
<html lang="en">
<head>
<meta charset="utf-8">
<meta http-equiv="X-UA-Compatible" content="IE=edge">
<title>Student Admission Webportal</title>
<meta name="description" content="Student Admission Webportal | DBMS Mini Project">
<meta name="viewport" content="width=device-width, initial-scale=1">
<script type="application/x-javascript">
addEventListener("load", function() {
setTimeout(hideURLbar, 0);
}, false);
function hideURLbar(){
window.scrollTo(0,1);
}
</script>
<link rel="stylesheet" href="https://cdnjs.cloudflare.com/ajax/libs/font-awesome/4.7.0/css/font-awesome.min.css">
<link rel="stylesheet" href="./css/styles.css">
</head>
<body>
<form action="php/admin.php" method="POST">
<div class="admin-login">
<input type="submit" name="admin" value="Admin" id="admin">
</div>
</form>
<h1 class="main-heading">Student Application 2019-20</h1>
<main class="container">
<p>Fill this application to apply for an admission IIIT Nagpur's BTech Programme.</p>
<form action="php/feedback.php" method="POST" class="admission-form">
<div class="student-details">
<h3>Student Details</h3>
<label>Student Name
<input type="text" name="name" id="name">
</label>
<br><br>
<label>Gender
<select name="gender" id="gender">
<option value="M">Male</option>
<option value="F">Female</option>
</select>
</label>
<br><br>
<label>Blood Group
<select name="blood-grp" id="blood-grp">
<option value="A+">A+</option>
<option value="A-">A-</option>
<option value="B+">B+</option>
<option value="B-">B-</option>
<option value="AB+">AB+</option>
<option value="AB-">AB-</option>
<option value="O+">O+</option>
<option value="O-">O-</option>
</select>
</label>
<br><br>
<label>Date of Birth
<input type="date" name="dob" id="dob">
</label>
<br><br>
<label>Mobile No 1
<input type="text" name="mob1" id="mob1">
</label>
<br><br>
<label>Mobile No 2
<input type="text" name="mob2" id="mob2">
</label>
<br><br>
<label>Email
<input type="email" name="email" id="email">
</label>
<br><br>
<label>Aadhaar Number
<input type="text" name="aadhar" id="aadhar">
</label>
<br><br>
<label>Father's Name
<input type="text" name="f_name" id="f_name">
</label>
<br><br>
<label>Father's Occupation
<input type="text" name="f_occ" id="f_occ">
</label>
<br><br>
<label>Mother's Name
<input type="text" name="m_name" id="m_name">
</label>
<br><br>
<label>Mother's Occupation
<input type="text" name="m_occ" id="m_occ">
</label>
<br><br>
<label>Branch
<select name="branch" id="branch">
<option value="CSE">CSE</option>
<option value="ECE">ECE</option>
</select>
</label>
<br><br>
<label>Minority Detail
<select name="minority" id="minority">
<option value="None">None</option>
<option value="Muslim">Muslim</option>
<option value="Jain">Jain</option>
<option value="Sikh">Sikh</option>
<option value="Christian">Christian</option>
</select>
</label>
<br><br>
<label>Phyically Disabled
<select name="disability" id="disability">
<option value="No">No</option>
<option value="Yes">Yes</option>
</select>
</label>
<br><br>
</div>
<div class="jee-details">
<h3>JEE Details</h3>
<label>Round of Allotment
<input type="text" name="jee-round" id="jee-round">
</label>
<br><br>
<label>JEE Roll No
<input type="text" name="jee-roll" id="jee-roll">
</label>
<br><br>
<label>JEE AIR
<input type="text" name="jee-rank" id="jee-rank">
</label>
<br><br>
<label>JEE Mark
<input type="text" name="jee-mark" id="jee-mark">
</label>
<br><br>
<label>JEE Score
<input type="text" name="jee-score" id="jee-score">
</label>
<br><br>
<label>JEE Year
<input type="text" name="jee-year" id="jee-year">
</label>
<br><br>
<label>Allotment Category
<select name="allotment-category" id="allotment-category">
<option value="OP">OP</option>
<option value="SC">SC</option>
<option value="ST">ST</option>
<option value="OBC">OBC</option>
<option value="EWS">EWS</option>
<option value="PD">PD</option>
</select>
</label>
<br><br>
<label>Candidate Category
<select name="candidate-category" id="candidate-category">
<option value="OP">OP</option>
<option value="SC">SC</option>
<option value="ST">ST</option>
<option value="OBC">OBC</option>
<option value="PD">PD</option>
</select>
</label>
<br><br>
</div>
<div class="fees-details">
<h3>Fees Details</h3>
<table>
<tr>
<th id="sr-no">Sr. No.</th>
<th>Details</th>
<th>DD/ECS No.</th>
<th>Date</th>
<th>Amount</th>
</tr>
<tr>
<td>1</td>
<td>JoSSA 2019 counseling</td>
<td><input type="text" name="fees-no-1" id="fees-no-1" placeholder="DD/ECS No."></td>
<td><input type="date" name="fees-date-1" id="fees-date-1"></td>
<td><input type="text" name="fees-amt-1" id="fees-amt-1" placeholder="Rs."></td>
</tr>
<tr>
<td>2</td>
<td>At Institute Reporting</td>
<td><input type="text" name="fees-no-2" id="fees-no-2" placeholder="DD/ECS No."></td>
<td><input type="date" name="fees-date-1" id="fees-date-1"></td>
<td><input type="text" name="fees-amt-2" id="fees-amt-2" placeholder="Rs."></td>
</tr>
</table>
<br>
</div>
<div class="hostel-details">
<h3>Hostel Details</h3>
<label>Hostel Required
<select name="hostel-req" id="hostel-req">
<option value="YES">YES</option>
<option value="NO">NO</option>
</select>
</label>
<br>
<h4>List of Enclosures</h4>
<label>1) Seat Allotment Letter
<select name="encl-1" id="encl-1">
<option value="YES">YES</option>
<option value="NA">NA</option>
</select>
</label>
<br><br>
<label>2) JEE Rank Card
<select name="encl-2" id="encl-2">
<option value="YES">YES</option>
<option value="NA">NA</option>
</select>
</label>
<br><br>
<label>3) Photo ID Proof
<select name="encl-3" id="encl-3">
<option value="YES">YES</option>
<option value="NA">NA</option>
</select>
</label>
<br><br>
<label>4) Certificate for Date of Birth
<select name="encl-4" id="encl-4">
<option value="YES">YES</option>
<option value="NA">NA</option>
</select>
</label>
<br><br>
<label>5) Qualifying Examination Mark-Sheet
<select name="encl-5" id="encl-5">
<option value="YES">YES</option>
<option value="NA">NA</option>
</select>
</label>
<br><br>
<label>6) Income Certificate (For EWS)
<select name="encl-6" id="encl-6">
<option value="YES">YES</option>
<option value="NA">NA</option>
</select>
</label>
<br><br>
<label>7) Cast Certificate
<select name="encl-7" id="encl-7">
<option value="YES">YES</option>
<option value="NA">NA</option>
</select>
</label>
<br><br>
<label>8) Cast Validity
<select name="encl-8" id="encl-8">
<option value="YES">YES</option>
<option value="NA">NA</option>
</select>
<p>*If caste certificate issued by Maharashtra Govt.</p>
</label>
<label>9) Seat Allotment Letter
<select name="encl-9" id="encl-9">
<option value="YES">YES</option>
<option value="NA">NA</option>
</select>
</label>
<br><br>
<label>10) Non-Creamy layer Certificate for OBC Category
<select name="encl-10" id="encl-10">
<option value="YES">YES</option>
<option value="NA">NA</option>
</select>
</label>
<br><br>
<label>11) Transfer Certificate
<select name="encl-11" id="encl-11">
<option value="YES">YES</option>
<option value="NA">NA</option>
</select>
</label>
<br><br>
<label>12) Migration Certificate
<select name="encl-12" id="encl-12">
<option value="YES">YES</option>
<option value="NA">NA</option>
</select>
</label>
<br><br>
<label>13) Aadhaar Card
<select name="encl-13" id="encl-13">
<option value="YES">YES</option>
<option value="NA">NA</option>
</select>
</label>
<br><br>
<label>14) GAP Certificate
<select name="encl-14" id="encl-14">
<option value="YES">YES</option>
<option value="NA">NA</option>
</select>
</label>
<br><br>
</div>
<div class="address-details">
<h3>Address Details</h3>
<table>
<tr>
<th></th>
<th>Address for Correspondence</th>
<th>Permanent Address</th>
</tr>
<tr id="add-row">
<td>Address</td>
<td><textarea rows="5" name="add-1" id="add-1"></textarea></td>
<td><textarea rows="5" name="add-2" id="add-2"></textarea></td>
</tr>
<tr>
<td>City</td>
<td><input type="text" name="add-city-1" id="add-city-1"></td>
<td><input type="text" name="add-city-2" id="add-city-2"></td>
</tr>
<tr>
<td>State</td>
<td><input type="text" name="add-state-1" id="add-state-1"></td>
<td><input type="text" name="add-state-2" id="add-state-2"></td>
</tr>
<tr>
<td>Pincode</td>
<td><input type="text" name="add-pincode-1" id="add-pincode-1"></td>
<td><input type="text" name="add-pincode-2" id="add-pincode-2"></td>
</tr>
<tr>
<td>Mobile No</td>
<td><input type="text" name="add-mob-1" id="add-mob-1"></td>
<td><input type="text" name="add-mob-2" id="add-mob-2"></td>
</tr>
</table>
<br>
</div>
<div class="education-details">
<h3>Education Details</h3>
<table>
<tr>
<th>Class</th>
<th>Name of Board</th>
<th>Subject</th>
<th>Year of Passing</th>
<th>Marks Obtained</th>
<th>Percentage/ Grade</th>
</tr>
<tr>
<td>10th / SSC</td>
<td><input type="text" name="ed-board-1" id="ed-board-1"></td>
<td><input type="text" name="ed-sub-1" id="ed-sub-1"></td>
<td><input type="text" name="ed-year-1" id="ed-year-1"></td>
<td><input type="text" name="ed-marks-1" id="ed-marks-1"></td>
<td><input type="text" name="ed-grade-1" id="ed-grade-1"></td>
</tr>
<tr>
<td>12th / HSC</td>
<td><input type="text" name="ed-board-2" id="ed-board-2"></td>
<td><input type="text" name="ed-sub-2" id="ed-sub-2"></td>
<td><input type="text" name="ed-year-2" id="ed-year-2"></td>
<td><input type="text" name="ed-marks-2" id="ed-marks-2"></td>
<td><input type="text" name="ed-grade-2" id="ed-grade-2"></td>
</tr>
</table>
</div>
<div class="education-details-2">
<h4>Scanned copies of documents uploaded?</h4>
<label>1) 10th Marksheet
<select name="file-1" id="file-1">
<option value="YES">YES</option>
<option value="NO">NO</option>
</select>
</label>
<br><br>
<label>2) 12th Marksheet
<select name="file-2" id="file-2">
<option value="YES">YES</option>
<option value="NO">NO</option>
</select>
</label>
<br><br>
<label>3) Aadhaar
<select name="file-3" id="file-3">
<option value="YES">YES</option>
<option value="NO">NO</option>
</select>
</label>
<br><br>
<label>4) Category Certificate
<select name="file-4" id="file-4">
<option value="YES">YES</option>
<option value="NO">NO</option>
</select>
</label>
<br><br>
<label>5) PWD Certificate
<select name="file-5" id="file-5">
<option value="YES">YES</option>
<option value="NO">NO</option>
</select>
</label>
<br><br>
<label>6) EWS Certificate
<select name="file-6" id="file-6">
<option value="YES">YES</option>
<option value="NO">NO</option>
</select>
</label>
<br><br>
</div>
<div class="health-details">
<h4>Whether suffering from any chronic disease</h4>
<select name="disease" id="disease">
<option value="NO">NO</option>
<option value="YES">YES</option>
</select>
<p>If yes, please provide detailed information.</p>
<textarea rows="5" name="dis-details" id="dis-details"></textarea>
<br><br>
</div>
<div class="declaration-details">
<h4>Declaration by the applicant</h4>
<p>I certified that all information provided by me in this form is correct to the best of my knowledge and belief. I understand that any willful misrepresentation of facts will result in my dismissal from the Institute. If admitted, I shall abide by all rules and regulations of the Institute.</p>
<label>Date
<input type="date" name="date" id="date">
</label>
<br><br><br>
<label>Signature of Applicant
<div class="upload-file">
<i class="fa fa-upload" aria-hidden="true"></i>
Upload
<input type="file" name="sign" id="sign">
</div>
</label>
<br><br>
</div>
<div class="submit-form">
<input type="submit" name="submit" value="Submit" id="submit">
</div>
</form>
<br>
</main>
<footer class="copyright-text">
<p>© Copyright Anushka Chauhan 2021 </p>
</footer>
</body>
</html>