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 : 3.137.168.126
<div id='app_no_div'><span id='app_no_div_span' ></span></div>
<div id="table_left_div">
<table id="table_content">
<tr>
<td id="table_col1">1. PGCET Centre
</td>
<td id="table_col2">:
</td><td id="table_col2"><select id="fcntrcode" style="width:200px;">
</select>
</td>
</tr>
<tr>
<td id="table_col1">2. Course / Subject applied for<font color="red">*</font>
</td>
<td id="table_col2">:
</td><td id="table_col2"><select id="fsubcode" style="width:200px;">
</select>
</td>
</tr>
<tr>
<td id="table_col1">3. First Name <font color="red">*</font>
</td>
<td id="table_col2">:
</td>
<td id="table_col3"><input type="text" id="fname" onblur='this.value=this.value.toUpperCase();' style="width:200px;"/>
</td>
</tr>
<tr>
<td id="table_col1">4. Middle Name<font color="red"></font>
</td>
<td id="table_col2">:
</td>
<td id="table_col3"><input type="text" onblur='this.value=this.value.toUpperCase();' id="fmotname" style="width:200px;"/>
</td>
</tr>
<tr>
<td id="table_col1">5. Last Name<font color="red"></font>
</td>
<td id="table_col2">:
</td>
<td id="table_col3"><input type="text" onblur='this.value=this.value.toUpperCase();' id="ffatname" style="width:200px;"/>
</td>
</tr>
<tr>
<td id="table_col1">6. Date of Birth (dd/mm/yyyy)<font color="red">*</font>
</td>
<td id="table_col2">:
</td>
<td id="table_col3"><input type="text" id="fdob" value='' maxlength=10 onkeypress="return acceptNumbersOnlyForModule(event);" onblur="if(trim(this.value)=='') this.value='';" style="width:200px;"/>
</td>
</tr>
<tr>
<td id="table_col1">7. Gender<font color="red">*</font>
</td>
<td id="table_col2">:
</td>
<td id="table_col3">Male:<input type="radio" name="fgender" value="Male" checked="checked"/> Female: <input type="radio" name="fgender" value="Female"/> 3rd Gender: <input type="radio" name="fgender" value="3rdGen"/>
</td>
</tr>
<tr>
<td id="table_col1">8. Domicile<font color="red"></font>
</td>
<td id="table_col2">:
</td>
<td id="table_col3">Karnataka:<input type="radio" name="fdomicile" value="Karnataka" checked="checked"/> Non Karnataka: <input type="radio" name="fdomicile" value="NonKarnataka"/>
</td>
</tr>
</table>
<table id="upload_table">
<tr>
<td style="width:282px;">9. Place of Birth (District)<font color="red">*</font>
</td>
<td style="width:20px;">:
</td>
<td style=""><input type="text" id="fpob" style="width:200px;"/>
</td>
<td>Select Photo:</td>
<td><input type="file" id="student_entry_upload" onchange="DisplayUserSelectedPhoto()" name="student_entry_upload" size="15"/></td>
</tr>
</table>
<table id="table_content">
<tr>
<td id="table_col1">10. Category<font color="red">*</font>
</td>
<td id="table_col2">:
</td>
<td id="table_col3"><select id="fcatcode" onchange="AssignDDAmount();" style="width:200px;"></select>
<input type="text" id="category_others" style="width:150px; display:none;"/>
</td>
</tr>
<tr>
<td id="table_col1">11. Religion<font color="red">*</font>
</td>
<td id="table_col2">:
</td>
<td id="table_col3"><input type="text" id="freligion" style="width:200px;"/>
</td>
</tr>
<tr>
<td id="table_col1">12. Caste<font color="red">*</font>
</td>
<td id="table_col2">:
</td>
<td id="table_col3"><input type="text" id="fcaste" style="width:200px;"/>
</td>
</tr>
<tr>
<td id="table_col1">13. Do you claim Reservation Under Physically disabled Quota ?<font color="red"></font>
</td>
<td id="table_col2">:
</td>
<td id="table_col3">Yes:<input type="radio" name="fph" value="Yes"/> No: <input type="radio" name="fph" value="No" checked="checked"/>
</td>
</tr>
<tr>
<td id="table_col1">14. Do you claim Reservation Under Ex-Serviceman Quota ?<font color="red"></font>
</td>
<td id="table_col2">:
</td>
<td id="table_col3">Yes:<input type="radio" name="fexserv" value="Yes"/> No: <input type="radio" name="fexserv" value="No" checked="checked"/>
</td>
</tr>
<tr>
<td id="table_col1">15. Do you claim Reservation Under NSS / NCC Quota ?<font color="red"></font>
</td>
<td id="table_col2">:
</td>
<td id="table_col3">Yes:<input type="radio" name="fnss" value="Yes"/> No: <input type="radio" name="fnss" value="No" checked="checked"/>
</td>
</tr>
<tr>
<td id="table_col1">16. Do you claim Reservation Under Sports Quota ?<font color="red"></font>
</td>
<td id="table_col2">:
</td>
<td id="table_col3">Yes:<input type="radio" name="fsports" value="Yes"/> No: <input type="radio" name="fsports" value="No" checked="checked"/>
</td>
</tr>
<tr>
<td id="table_col1">17. Do you claim Reservation Under 371 / J Quota ?<font color="red"></font>
</td>
<td id="table_col2">:
</td>
<td id="table_col3">Yes:<input type="radio" name="f371" value="Yes"/> No: <input type="radio" name="f371" value="No" checked="checked"/>
</td>
</tr>
<tr>
<td id="table_col1">18. Do you claim Reservation Under Project Displaced Quota ?<font color="red"></font>
</td>
<td id="table_col2">:
</td>
<td id="table_col3">Yes:<input type="radio" name="fproj" value="Yes"/> No: <input type="radio" name="fproj" value="No" checked="checked"/>
</td>
</tr>
<tr>
<td id="table_col1">19. Do you claim Reservation Under Rural Quota ?<font color="red"></font>
</td>
<td id="table_col2">:
</td>
<td id="table_col3">Yes:<input type="radio" name="frural" value="Yes"/> No: <input type="radio" name="frural" value="No" checked="checked"/>
</td>
</tr>
<tr>
<td id="table_col1">20. Do you claim Reservation Under Kannada Medium Quota ?<font color="red"></font>
</td>
<td id="table_col2">:
</td>
<td id="table_col3">Yes:<input type="radio" name="fkannada" value="Yes"/> No: <input type="radio" name="fkannada" value="No" checked="checked"/>
</td>
</tr>
<tr>
<td id="table_col1">21. Registration Fee<font color="red">*</font>
</td>
<td id="table_col2">:
</td>
<td id="table_col3"><input type="text" id="famount" disabled=true; onblur="if(empty(trim(this.value))) this.value='0.0'" value='800' onkeypress="return acceptNumbersOnlyForModule(event);" style="width:200px; text-align:right;font-weight:bold;"/>
</td>
</tr>
<tr>
<td id="table_col1">22. Qualifying exam<font color="red">*</font>
</td>
<td id="table_col2">:
</td>
<td id="table_col3"><input type="text" id="fqualexam" style="width:200px;"/>
</td>
</tr>
<tr>
<td id="table_col1">23. Qualifying exam Status ?<font color="red"></font>
</td>
<td id="table_col2">:
</td>
<td id="table_col3">Completed:<input type="radio" name="fqualify" value="Yes"/> Appeared: <input type="radio" name="fqualify" value="No" checked="checked"/>
</td>
</tr>
<tr>
<td id="table_col1">24. College<font color="red">*</font>
</td>
<td id="table_col2">:
</td>
<td id="table_col3"><input type="text" id="fcollname" style="width:200px;"/>
</td>
</tr>
<tr>
<td id="table_col1">25. University<font color="red">*</font>
</td>
<td id="table_col2">:
</td>
<td id="table_col3"><input type="text" id="funivname" style="width:200px;"/>
</td>
</tr>
<tr>
<td id="table_col1">26. Full Postal Address of the candidate<font color="red">*</font>
</td>
<td id="table_col2">:
</td>
<td id="table_col3"><textarea id="fadd1" rows="2" col="1" style="width:200px;"></textarea>
</td>
</tr>
<tr>
<td id="table_col1">27. Pin<font color="red">*</font>
</td>
<td id="table_col2">:
</td>
<td id="table_col3"><input type="text" id="fpincode" value='' maxlength=6 onkeypress="return acceptNumbersOnlyForModule(event);" style="width:200px;"/>
</td>
</tr>
<tr>
<td id="table_col1">28. Phone<font color="red">*</font>
</td>
<td id="table_col2">:
</td>
<td id="table_col3"><input type="text" id="fphone" style="width:200px;"/>
</td>
</tr>
<tr>
<td id="table_col1">29. Mobile<font color="red">*</font>
</td>
<td id="table_col2">:
</td>
<td id="table_col3"><input type="text" id="fmobile" style="width:200px;"/>
</td>
</tr>
<tr>
<td id="table_col1">30. Email<font color="red">*</font>
</td>
<td id="table_col2">:
</td>
<td id="table_col3"><input type="text" id="femail" style="width:200px;"/>
</td>
</tr>
<tr>
<td id="table_col1">31. Payment Mode<font color="red">*</font>
</td>
<td id="table_col2">:
</td>
<td id="table_col3"><select style="width:202px;" id="fpaymode"><option value="Select">Select</option><option value="NEFT">Other Banks</option> <option value="SYN">Syndicate Bank</option> </select>
</td>
</tr>
</table>
</div>
<div id="table_right_div">
<img src="img/default_photo.jpg" onchange="DisplayUserSelectedPhoto()" id="student_entry_photo">
</div>
<div style='clear:both;'>
<div class='submit_div' id='save_div'>
<div class='submit_div_button' onclick="saveStudentEntry();" ><div class='button_text'>Submit</div></div>
<div class='submit_div_button' onclick="ClearStudentEntry();"><div class='button_text'>Clear</div></div>
</div>
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