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Code Editor : system_general_master_setup_old.php
<script> $(function() { $('#reload').click(function(){ var d = new Date(); $('img').attr('src', 'captcha.php?' + d.getTime()); }); }); </script> <div class="portlet box blue"> <div class="portlet-title"> <div class="caption"> <i class="fa fa-reorder"></i>Registration Form </div> </div> <div class="portlet-body form" > <div style='margin-left:6%;'> <div class="row"> <!-- BEGIN FORM--> <h3 class="form-section">Student Details</h3> <form class="form-horizontal" id='form_module_details_upload' enctype='multipart/form-data' method='POST'> <div class="col-md-7" > <input type='hidden' name= 'MAX_FILE_SIZE' value='10000000000' /> <div class="form-body"> <div class="form-group"> <label class="col-md-3 control-label" style="text-align:left" >Roll Number <span style='color:red;'>*</span></label> <div class="col-md-3"> <input type="text" name="registerno" id="T1" class="form-control" style="text-transform: uppercase;min-width:150px;" title='University Register no.' maxlength=10 onblur='CMS.Getstudentdetails(event,this.value)' > </div> </div> <div class="form-group"> <label class="col-md-3 control-label" style="text-align:left" >Candidate name</label> <div class="col-md-7"> <input type="text" name="candidate_name" id="T2" class="form-control" disabled maxlength=100 > </div> </div> <div class="form-group"> <label class="col-md-3 control-label" style="text-align:left" >Department</label> <div class="col-md-7"> <input type="text" name="college" id="T3" class="form-control" disabled maxlength=100 > </div> </div> <div class="form-group"> <label class="col-md-3 control-label" style="text-align:left" >Degree</label> <div class="col-md-7"> <input type="text" name="degree" id="T4" class="form-control" disabled maxlength=100 > </div> </div> <div class="form-group"> <label class="col-md-3 control-label" style="text-align:left" >Candidate Name in Hindi <span style='color:red;'>*</span></label> <div class="col-md-7"> <input type="text" name="candidate_hiname" id="T20" class="form-control" onkeypress = 'CMS.onLoad(event)' maxlength=100 > </div> </div> <div class="form-group"> <label class="col-md-3 control-label" style="text-align:left" >Father's Name <span style='color:red;'>*</span></label> <div class="col-md-7"> <input type="text" name="candidate_fnamename" id="T21" class="form-control" maxlength=100 > </div> </div> <div class="form-group"> <label class="col-md-3 control-label" style="text-align:left" >Mother's Name <span style='color:red;'>*</span> </label> <div class="col-md-7"> <input type="text" name="candidate_mname" id="T25" class="form-control" maxlength=100 > </div> </div> <div class="form-group"> <label class="col-md-3 control-label" style="text-align:left" >Category</label> <div class="col-md-3"> <select class="form-control" id='T16' style='min-width:150px;' onchange='CMS.loadcnvcategoryfee(this.value)' title='Category'> <option value='00'>Select Category</option> <option value='SCST'>SC / ST</option> <option value='OTHERS'>OTHERS</option> </select> </div> </div> <!-- MY TASK BEGIN CONDENSED TABLE PORTLET--> <div class="span11" id='disp_scstatt' style='display:none;'><div class="portlet box blue"> <div class="portlet-title"> <i class="fa fa-cogs"></i> Upload Category Certificate </div> <div class="portlet-body"> <div class="scroller" data-height="380px"> <table id="upload_table" class="table table-bordered table-hover" cellpadding="0" cellspacing="0"> <thead> <tr> <th>#</th> <th><i class="icon-briefcase"></i> Document Type</th> <th>File </th> <th>Attachment</th> </tr> </thead> <tbody> <tr> <td style="width:30px">1</td> <td id="doc_upload_'.$int_code.'" style="width:300px">Category Certificate</td> <td style="width:300px"><div style="float:left;"><input type='hidden' id='categoryattpath' /><input type="file" name='categoryatt' id='categoryatt' /></div><div style="float:left;"><a class="btn btn-sm blue" href="#" onclick=CMS.UploadEmployeeDocuments('categoryatt')><i class="fa fa-upload"></i> Upload</a></div></td> <td style="width:100px" id="attach_td_cat"> </td> </tr> </tbody> </table> </div> </div> </div> </div> <div class="form-group"> <label class="col-md-3 control-label" style="text-align:left" for="p_dob">D.O.B. <span style='color:red;'>*</span></label> <div class="col-md-3"> <div class="input-icon"> <i class="fa fa-calendar"></i> <input type="text" placeholder="Date of Birth" style='min-width:150px;' id="T14" title='Date of Birth' class="form-control"> </div> <div class="help-block"> (in dd/mm/yyyy format) </div> </div> </div> <div class="form-group"> <label class="col-md-3 control-label" style="text-align:left" >Mobile no. <span style='color:red;'>*</span></label> <div class="col-md-3"> <input type="text" name="mobile no" id="T5" class="form-control" style='min-width:150px;' title='Mobile no.' onkeypress="return acceptNumbersOnlyForModule(event);" maxlength=10> </div> </div> <div class="form-group"> <label class="col-md-3 control-label" style="text-align:left" >Confirm Mobile no. <span style='color:red;'>*</span></label> <div class="col-md-3"> <input type="text" name="confirm mobile" id="T6" class="form-control" style='min-width:150px;' title='Confirm Mobile no.' onkeypress="return acceptNumbersOnlyForModule(event);" maxlength=10> </div> </div> <div class="form-group"> <label class="col-md-3 control-label" style="text-align:left" >Email Id. <span style='color:red;'>*</span></label> <div class="col-md-7"> <input type="text" name="email id" id="T7" class="form-control" style='min-width:150px;' style="text-transform: lowercase;" title='Email id.' maxlength=50> </div> </div> <div class="form-group"> <label class="col-md-3 control-label" style="text-align:left" >Postal Address <span style='color:red;'>*</span></label> <div class="col-md-7"> <input type="text" name="address" id="T8" class="form-control" maxlength=50 title='Postal Address'><br> <input type="text" name="address" id="T9" class="form-control" style='margin-top:-18px;' maxlength=50><br> <input type="text" name="address" id="T10" class="form-control" style='margin-top:-18px;' maxlength=50><br> <input type="text" name="address" id="T11" class="form-control" style='margin-top:-18px;' maxlength=50><br> </div> </div> <div class="form-group"> <label class="col-md-3 control-label" style="text-align:left" >Receive Certificate<span style='color:red;'>*</span></label> <div class="col-md-3"> <select class="form-control" id='T23' style='min-width:150px;' title='Receive Certificate'> <option value = '00'>Select</option> <option value = 'presence'>In Presence</option> <option value = 'absentia'>In Absentia</option> </select> </div> </div> <div class="form-group"> <label class="col-md-3 control-label" style="text-align:left" >Convocation<span style='color:red;'>*</span></label> <div class="col-md-7"> <input type="text" name="" id="T15" class="form-control" disabled > <!--<select class="form-control" id='T15'></select> --> </div> </div> <div class="form-group"> <label class="col-md-3 control-label" style="text-align:left" >Amount<span style='color:red;'>*</span></label> <div class="col-md-3"> <input type='hidden' value='' id='TH1' /> <input type="text" name="" value='0' id="T12" style='min-width:150px;' class="form-control" disabled maxlength=10> </div> </div> <div class="form-group"> <label class="col-md-3 control-label" style="text-align:left" >Payment Type <span style='color:red;'>*</span></label> <div class="col-md-4"> <select class="form-control" id='T13' style='min-width:200px;' ></select> </div> </div> </div> </div> <div class="col-md-3"> <div class="form-group"> <img id='student_entry_photo' style="width:148px;z-index:1;height:187px; width:148px" onchange="DiaplayUserSelectedPhoto()" src="img/default_photo.jpg" class="img-responsive" > </div> <div class="form-group"> <label class="control-label" style="margin:0">Choose a file to upload <span style='color:red;'>*</span></label> <input type="file" name="student_entry_upload" id="student_entry_upload" onchange='DisplayUserSelectedPhoto();' style="padding:0;width:200px;" class="form-control"> </div> </div> </form> </div> <div class="form-body"> <div class="row"> <h3 class="form-section">Declaration</h3> <div class="col-md-12"> <div class="form-group"> <p>I HEREBY SOLEMNLY DECLARE AND PROMISE THAT IF ADMITTED TO THE DEGREE FOR WHICH I HAVE BEEN RECOMMENDED, I SHALL IN MY DAILY LIFE AND CONVERSATION, CONDUCT MYSELF, AS BEFITS A MEMBER OF THIS UNIVERSITY THAT I SHALL TO THE UTMOST OF MY CAPACITY AND OPPORTUNITY, SUPPORT THE CAUSE OF MORALITY AND SOUND LEARNING, AND THAT, AS FAR AS IN ME LIES, I SHALL UPHELD AND ADVANCE THE SOCIAL ORDER AND THE WELL BEING OF MY FELLOWMEN IN THE CASE OF PROFESSIONAL DEGREE, THE FOLLOWING SHALL BE ADDED TO THE ABOVE DECLARATION. I SHALL FAITHFULLY AND CAREFULLY FULFIL THE DUTIES OF THE PROFESSION TO WHICH I MAY BE ADMITTED BY VIRTUE OF MY DEGREE, THAT I SHALL ON ALL OCCASIONS MAINTAIN ITS PURITY AND REPUTATION AND I SHALL NEVER DEVIATE FROM THE STRAIGHT PATH OF THEIR HONOURABLE EXCERCISE BY MAKING MY KNOWLEDGE SUBSERVIENT TO UNWORTHY ENDS.</p> <div class="col-md-12"> <div class="col-md-offset-10 col-md-9" style="padding-left:50px;"> I agree to the Terms <input type = "checkbox" id = "student_declr" /> </div> </div> <br><br> <!-- <p style='text-align:center;'>Please enter the letters displayed in the image below. If the image is not clear, click on "Can't read the text? Get a new image"</p> <php @session_start(); $_SESSION = array(); $main_src ="captcha/simple-php-captcha.php"; include($main_src); $_SESSION['captcha'] = simple_php_captcha(); ?> <php echo '<img src="' . $_SESSION['captcha']['image_src'] . '" alt="CAPTCHA code">'; ?> </div> </div> </div> <div class="row"> <div class="col-md-2"> <div class="form-group"> <input type="text" id='passing_year' placeholder="enter letters displayed above" class="form-control"> </div> </div> </div> --> </div> </div> <div class="form-actions fluid"> <div class="row"> <div class="col-md-12"> <div class="col-md-offset-10 col-md-9" > <button class="btn purple" onclick='CMS.SendMailOtPToUser();' type="button"><i class="fa fa-check"></i> Submit</button> <button class="btn red" onclick='home();' type="button" ><i class="fa fa-times">Cancel</i></button> </div> </div> </div> </div> </div> </div> <!-- END Row-->
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