Linux ip-172-26-7-228 5.4.0-1103-aws #111~18.04.1-Ubuntu SMP Tue May 23 20:04:10 UTC 2023 x86_64
Your IP : 18.119.253.198
<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" >Register no. <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" >College / 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" >Category</label>
<div class="col-md-3">
<input type="text" name="Category" id="T16" class="form-control" disabled maxlength=100 >
</div>
</div>
<div class="form-group">
<label class="col-md-3 control-label" style="text-align:left" >Kannada Name</label>
<div class="col-md-3">
<input type="text" name="Kannada Name" id="T99" class="form-control" onkeypress = 'CMS.onLoad(event)'; maxlength=100 >
</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>
<span style = 'color:red'>OTP will be sent to email id.</span>
<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 <b>(Selfie Image Will Be Rejected)</b> <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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