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<?php
include ("include/makeSession.php");
$installment_id=mysqli_query($con,"select * from admin where id='".$_SESSION["ecomid"]."'");
$installment_id=mysqli_fetch_array($installment_id);
$installment_id=$installment_id['menuper'];
$menuper=explode(',',$installment_id);
if(in_array('D.EI.ED.ADMISSION',$menuper)){
}else{
header("location:index.php");
}
include("include/header.php");
//include("include/sidebar.php");
if(isset($_REQUEST['upid']) && $_REQUEST['upid']!=''){
$dovalue="editrest";
$doid=$_REQUEST['upid'];
$upuserresult=mysqli_query($con,"select * from restaurant where id='".$_REQUEST['upid']."'");
$upuserarr=mysqli_fetch_array($upuserresult);
}else{
$dovalue="addrest";
$doid='';
}
?>
<div style="background-color:#999">
<div id="ContentPlaceHolder1_pnlStudentInfo">
<input name="hfpercentage" id="hfpercentage" value="0" type="hidden">
<input name="hfTotal" id="hfTotal" value="0" type="hidden">
<input name="hfPayable" id="hfPayable" value="0" type="hidden">
<input name="hfSession" id="hfSession" value="NA" type="hidden">
<input name="hfApplicant" id="hfApplicant" value="NA" type="hidden">
<div class="content-wrapper">
<div class="container">
<div id="div99">
<div id="divHeader" class="row">
<div class="col-md-12">
<h1 class="page-head-line" style="text-align: center;">Application Form For Two Years D.El.Ed Training Course<br>
<span style="text-align: center;font-size: 12px;">(Please Read All The Instruction Before Fillup The Form)</span> </h1>
</div>
<div class="col-md-12"> <span id="lblFormNo" class="twitterStyleTextbox" style="color:#CC0000;font-family:Verdana;font-weight:bold;"></span>
<h1 class="page-head-line">Session :
<select name="ctl00$ContentPlaceHolder1$ddlSession" id="ContentPlaceHolder1_ddlSession" class="twitterStyleselect" required="required">
<option value="Select Session">Select Session</option>
<option value="1">2015-2017</option>
<option value="2">2016-2018</option>
<option value="3">2017-2019</option>
<option value="4">2017-2019</option>
<option value="5">2018-2020</option>
<option value="6">2019-2021</option>
<option value="7">2020-2022</option>
</select>
<span id="ContentPlaceHolder1_CompareValidator1" style="color:Red;font-size:14px;visibility:hidden;">* Please Select Session</span> <span id="rfvddlSession" style="color:#F8F8F8;display:none;">*</span>
<input name="vcerfvddlSession_ClientState" id="vcerfvddlSession_ClientState" type="hidden">
</h1>
</div>
</div>
<div class="row">
<div class="col-md-12">
<div class="panel panel-blue">
<div class="panel-heading">BASIC INFORMATION</div>
<div class="panel-body pan">
<div id="divInsertApplicant" class="form-body pal">
<div class="row">
<div class="col-md-4">
<div class="form-group">
<div class="input-icon"> <i class="fa fa-user"></i>
<input name="ctl00$ContentPlaceHolder1$txtApplicantName" type="text" id="ContentPlaceHolder1_txtApplicantName" required="required" placeholder="Applicant Name*" data-placement="bottom" class="form-control" data-original-title="Enter Your Name" onkeypress="return isAlphabet(event);" title="" data-toggle="tooltip">
</div>
</div>
</div>
<div class="col-md-4">
<div class="form-group">
<div class="input-icon"> <i class="fa fa-user"></i>
<input name="ctl00$ContentPlaceHolder1$txtFatherName" type="text" id="ContentPlaceHolder1_txtFatherName" required="required" placeholder="Father Name*" data-placement="bottom" class="form-control" data-original-title="Enter Your Father's Name(Note: If Not Present Mention 'Late' Bafore Name)" onkeypress="return isAlphabet(event);" title="" data-toggle="tooltip">
</div>
</div>
</div>
<div class="col-md-4">
<div class="form-group">
<div class="input-icon"> <i class="fa fa-user"></i>
<input name="ctl00$ContentPlaceHolder1$txtMotherName" type="text" id="ContentPlaceHolder1_txtMotherName" class="form-control" placeholder="Mother Name*" data-toggle="tooltip" data-placement="bottom" title="" onkeypress="return isAlphabet(event);" data-original-title="Enter Your Mother's Name(Note: If Not Present Mention 'Late' Bafore Name)">
</div>
</div>
</div>
<div class="col-md-3" style="display:none;">
<div class="form-group">
<div class="input-icon"> <i class="fa fa-users"></i>
<input name="ctl00$ContentPlaceHolder1$txtGuardianName" type="text" id="ContentPlaceHolder1_txtGuardianName" class="form-control" placeholder="Guardian Name" data-toggle="tooltip" data-placement="bottom" title="" onkeypress="return isAlphabet(event);" data-original-title="Enter Name Of Your Guardian">
</div>
</div>
</div>
</div>
<div class="row">
<div class="col-md-3">
<div class="form-group">
<select name="ctl00$ContentPlaceHolder1$ddlGender" id="ContentPlaceHolder1_ddlGender" class="form-control" placeholder="Select Gender*" required="required">
<option value="1">Male</option>
<option value="2">Female</option>
</select>
</div>
</div>
<div class="col-md-3">
<div class="form-group">
<div class="input-group date" id="txtDOBDatepicker">
<input name="ctl00$ContentPlaceHolder1$txtDOB" id="ContentPlaceHolder1_txtDOB" required="required" placeholder="DOB(DD/MM/YYYY)*" data-placement="top" class="form-control" data-original-title="Enter Your Date Of Birth" type="text" title="" data-toggle="tooltip">
</div>
</div>
</div>
<div class="col-md-3">
<div class="form-group">
<select name="ctl00$ContentPlaceHolder1$ddlCategory" id="ContentPlaceHolder1_ddlCategory" class="form-control" data-toggle="tooltip" data-placement="bottom" title="" required="required" data-original-title="Select Your Category*">
<option value="Select Category">Select Category</option>
<option value="1">GENERAL</option>
<option value="2">SC</option>
<option value="3">ST</option>
<option value="4">OBC</option>
<option value="5">OBC-A</option>
<option value="6">OBC-B</option>
<option value="7">OTHERS</option>
</select>
<span id="ContentPlaceHolder1_RequiredFieldValidator2" style="color:Red;font-size:14px;visibility:hidden;">* Please Select Category</span> </div>
</div>
<div class="col-md-3">
<div class="form-group">
<div class="input-icon"> <i class="fa fa-envelope"></i>
<input name="ctl00$ContentPlaceHolder1$txtMail" type="email" id="ContentPlaceHolder1_txtMail" pattern="/^[a-zA-Z0-9.!#$%&'*+/=?^_`{|}~-]+@[a-zA-Z0-9-])*$/" required="required" placeholder="Mail ID*" data-placement="bottom" class="form-control" data-original-title="Enter Your Email Address" title="" data-toggle="tooltip">
</div>
</div>
</div>
</div>
<div class="row">
<div class="col-md-3">
<div class="form-group">
<div class="input-icon"> <i class="fa fa-phone"></i>
<input name="ctl00$ContentPlaceHolder1$txtContactNo" type="text" id="ContentPlaceHolder1_txtContactNo" class="form-control" placeholder="Contact No" data-toggle="tooltip" data-placement="bottom" title="" onkeypress="return isNumeric(event);" data-original-title="Enter Your Contact No.">
</div>
</div>
</div>
<div class="col-md-3">
<div class="form-group">
<div class="input-icon"> <i class="fa fa-mobile"></i>
<input name="ctl00$ContentPlaceHolder1$txtMobileNo" type="text" id="ContentPlaceHolder1_txtMobileNo" pattern="\d{10}" required="required" placeholder="Mobile No*" data-placement="bottom" maxlength="10" class="form-control" data-original-title="Enter Your 10 digit phone no" onkeypress="return isNumeric(event);" title="" data-toggle="tooltip">
</div>
</div>
</div>
<div class="col-md-3 hide">
<div class="form-group">
<div class="input-icon"> <i class="fa fa-sort-numeric-desc"></i>
<input name="ctl00$ContentPlaceHolder1$txtAdhar" type="text" id="ContentPlaceHolder1_txtAdhar" pattern="\d{12}" placeholder="Aadhaar No" data-placement="bottom" maxlength="12" class="form-control" data-original-title="Enter Your 12 Digit Aadhar No" onkeypress="return isNumeric(event);" aria-describedby="tooltip294630" title="" data-toggle="tooltip">
<div class="tooltip fade bottom in" role="tooltip" id="tooltip294630" style="top: 34px; left: 37px; display: block;">
<div class="tooltip-arrow"></div>
<div class="tooltip-inner">Enter Your 12 Digit Aadhar No</div>
</div>
</div>
</div>
</div>
<div class="col-md-3">
<div class="form-group">
<select name="ctl00$ContentPlaceHolder1$ddlReligion" id="ContentPlaceHolder1_ddlReligion" class="form-control" data-toggle="tooltip" data-placement="bottom" title="" required="required" data-original-title="Select Your Religion">
<option value="1">HINDU</option>
<option value="2">MUSLIM</option>
<option value="3">SHIKH</option>
<option value="4">BUDDHIST</option>
</select>
</div>
</div>
<div class="col-md-3">
<div class="form-group">
<select name="ctl00$ContentPlaceHolder1$ddlConsultant" id="ContentPlaceHolder1_ddlConsultant" class="form-control">
<option value="0">Select Consultant</option>
<option value="2">Amol dai</option>
</select>
</div>
</div>
</div>
</div>
</div>
</div>
</div>
</div>
<div class="row">
<div class="col-md-12">
<div class="panel panel-blue">
<div class="panel-heading">PERMANENT ADDRESS</div>
<div class="panel-body pan">
<div class="form-body pal">
<div class="row" style="display:none;">
<div class="col-md-4">
<div class="form-group">
<select name="ctl00$ContentPlaceHolder1$ddlState" id="ContentPlaceHolder1_ddlState" class="form-control" data-toggle="tooltip" data-placement="bottom" title="" data-original-title="Select Your State">
<option selected="selected" value="">Select State*</option>
<option value="35">Andaman & Nicobar</option>
<option value="1">Andra Pradesh</option>
<option value="2">Arunchal Pradesh</option>
<option value="3">Assam</option>
<option value="4">Bihar</option>
<option value="29">Chandigarh</option>
<option value="5">Chhattisgarh</option>
<option value="30">Dadar and Nagar Haveli</option>
<option value="31">Daman and Diu</option>
<option value="32">Delhi</option>
<option value="6">Goa</option>
<option value="7">Gujarat</option>
<option value="8">Haryana</option>
<option value="9">Himachal Pradesh</option>
<option value="10">Jammu and Kashmir</option>
<option value="11">Jharkhand</option>
<option value="12">Karnataka</option>
<option value="13">Kerala</option>
<option value="33">Lakshadeep</option>
<option value="14">Madya Pradesh</option>
<option value="15">Maharashtra</option>
<option value="16">Manipur</option>
<option value="17">Meghalaya</option>
<option value="18">Mizoram</option>
<option value="19">Nagaland</option>
<option value="20">Orissa</option>
<option value="34">Pondicherry</option>
<option value="21">Punjab</option>
<option value="22">Rajasthan</option>
<option value="23">Sikkim</option>
<option value="24">Tamil Nadu</option>
<option value="36">Telangana</option>
<option value="25">Tripura</option>
<option value="27">Uttar Pradesh</option>
<option value="26">Uttaranchal</option>
<option value="28">West Bengal</option>
</select>
</div>
</div>
<div class="col-md-4">
<div class="form-group">
<input name="ctl00$ContentPlaceHolder1$txtDistrict" type="text" id="ContentPlaceHolder1_txtDistrict" class="form-control" placeholder="District Name*" data-toggle="tooltip" data-placement="bottom" title="" onkeypress="return isAlphabet(event);" data-original-title="Enter Your District Name">
</div>
</div>
<div class="col-md-4">
<div class="form-group">
<div class="input-icon"> <i class="fa fa-sort-numeric-desc"></i>
<input name="ctl00$ContentPlaceHolder1$txtPIN" type="text" id="ContentPlaceHolder1_txtPIN" pattern="\d{6}" placeholder="PIN Code*" data-placement="bottom" maxlength="6" class="form-control" data-original-title="enter six digit pin code" onkeypress="return isNumeric(event);" title="" data-toggle="tooltip">
</div>
</div>
</div>
</div>
<div class="row">
<div class="col-md-8">
<div class="form-group">
<textarea name="ctl00$ContentPlaceHolder1$txtAddress" id="ContentPlaceHolder1_txtAddress" required="required" placeholder="Postal Address*" data-placement="bottom" class="form-control" data-original-title="Enter Your Address" style="height:50px;" rows="2" cols="20" title="" data-toggle="tooltip"></textarea>
</div>
</div>
</div>
</div>
</div>
</div>
</div>
</div>
<div id="div2" class="row">
<div class="col-md-12">
<div class="panel panel-blue">
<div class="panel-heading">ACADEMIC INFORMATION (H.S, 10+2 OR EQUIVALENT)</div>
<div class="panel-body pan">
<div class="form-body pal">
<div class="row">
<div class="col-md-4" style="display:none;">
<div class="form-group">
<div class="input-icon"> <i class="fa fa-university"></i>
<input name="ctl00$ContentPlaceHolder1$txtInsStudied" type="text" id="ContentPlaceHolder1_txtInsStudied" class="form-control" placeholder="Institute Name*" data-toggle="tooltip" data-placement="bottom" title="" data-original-title="H.S or its equivalnt">
</div>
</div>
</div>
<div class="col-md-4">
<div class="form-group">
<div id="up3">
<select name="ctl00$ContentPlaceHolder1$ddlMedium" id="ContentPlaceHolder1_ddlMedium" class="form-control" data-toggle="tooltip" data-placement="bottom" title="" required="required" data-original-title="Select Medium">
<option value="Select Medium">Select Medium</option>
<option value="1">ENGLISH</option>
<option value="2">HINDI</option>
<option value="3">BENGALI</option>
</select>
<span id="ContentPlaceHolder1_CompareValidator2" style="color:Red;font-size:14px;visibility:hidden;">* Please Select Medium</span> </div>
</div>
</div>
</div>
<div class="fff">
<div class="row">
<div class="col-md-12">
<h3 style="color: #337ab7; font-size: 14px; font-weight: 600;">Statement Of Marks In The H.S,10+2 Or Equivalent Examination Passed By The Applicant</h3>
</div>
</div>
<div class="row">
<div class="col-md-4">
<div class="form-group">
<input name="txtExamination" value="HS,10+2/Equivalent Examination" readonly="readonly" id="txtExamination" class="form-control" placeholder="HS/Equivalent Examination name*" data-toggle="tooltip" data-placement="bottom" title="" required="required" data-original-title="Enter Examination Name" type="text">
</div>
</div>
<div class="col-md-4">
<div class="form-group">
<select name="ctl00$ContentPlaceHolder1$ddlBoardCouncil" id="ContentPlaceHolder1_ddlBoardCouncil" class="form-control" data-toggle="tooltip" data-placement="bottom" placeholder="Select Baord/Council*" title="" required="required" data-original-title="Select Your Board/Council">
<option value="Select Board/Council">Select Board/Council</option>
<option value="1">West Bengal State Council of Vocational Education &amp; Training (WBSCVET)</option>
<option value="2">West Bengal Council of Higher Secondary Education</option>
<option value="3">West Bengal Council for Rabindra Open Schooling</option>
<option value="4">WEST BENGAL BOARD OF MADRASA EDUCATION</option>
<option value="5">Visva-Bharati University</option>
<option value="6">Uttranchal Shiksha Evm Pariksha ParishacL Ram Nagar</option>
<option value="7">U.R Board of High School &amp; Intermediate Education</option>
<option value="8">Tripura Board of Secondary Education</option>
<option value="9">Tamil Nadu State Open School</option>
<option value="10">Tamil Nadu Board of Higher Secondary Education</option>
<option value="11">>Rashtriya Sanskrit Sansthan</option>
<option value="12">Rajasthan State Open School</option>
<option value="13">Punjab School Education Board</option>
<option value="14">Orissa Council of Higher Secondary Education </option>
<option value="15">National Institute of Open Schooling (formally National Open School)</option>
<option value="16">Nagaland Board of School Education</option>
<option value="17">Mizoram Board of School Education Chaltlan</option>
<option value="18">Meghalaya Board of School Education</option>
<option value="19">Manipur Council of Higher Secondary Education</option>
<option value="20">Maharashtra State Board of Secondary and Higher</option>
<option value="21">M.P State Open School</option>
<option value="22">Kerala State Open School</option>
<option value="23">Kerala Board of Public Examinations</option>
<option value="24">Kerala Board of Higher Secondary Education</option>
<option value="25">Karnataka Open School, J.S.S. Maha Vidya Pccth</option>
<option value="26">Karnataka Board of the Pre-University Education</option>
<option value="27">Jharkhand Academic Council</option>
<option value="28">Jamia Miliya Islamia</option>
<option value="29">J&amp;K State Open School</option>
<option value="30">J&amp;K State Board of School Education</option>
<option value="31">International Baccalaureate - Asia Pacific</option>
<option value="32">Himachal Pradesh State Open School</option>
<option value="33">Himachal Pradesh Board of School Education</option>
<option value="34">Haryana Open School</option>
<option value="35">Haryana Board of Education</option>
<option value="36">Gurukul Kangri Vishwavidyalaya</option>
<option value="37">Gujarat State Open School</option>
<option value="38">Gujarat Secondary &amp; Higher Secondary Education Board</option>
<option value="39">Goa Board of Secondary &amp; Higher Secondary Education</option>
<option value="40">GCSE Programme from University of Cambridge (International Exam)</option>
<option value="41">Directorate of Army Education</option>
<option value="42">Council for Indian School Certificate Examinations</option>
<option value="43">Chhatisgarh Board of Secondary Education &amp; Stale Open School</option>
<option value="44">CENTRAL BOARD OF SECONDARY EDUCATION (CBSE)</option>
<option value="45">Bihar Sanskrit Shiksha Board</option>
<option value="46">Bihar Intermediate Education Council</option>
<option value="47">Banasthali Vidyapith, Banasthali</option>
<option value="48">Assam Higher Secondary Education Council</option>
<option value="49">Asam Higher Secondary Education Council</option>
<option value="50">Andhra Pradesh Open School Society, SCERT Campus</option>
<option value="51">Aligarh Muslim University</option>
</select>
<span id="ContentPlaceHolder1_rff" style="color:Red;visibility:hidden;">Select Board/Council*</span> </div>
</div>
<div class="col-md-4">
<div class="form-group">
<div class="input-group date" id="PassingYearDatepicker">
<input name="ctl00$ContentPlaceHolder1$txtYearOfPassing" id="ContentPlaceHolder1_txtYearOfPassing" required="required" placeholder="Year of passing*" data-placement="top" class="form-control" data-original-title="Enter Year Of Passing The Examination" type="text" title="" data-toggle="tooltip">
</div>
</div>
</div>
</div>
<div class="table-responsive">
<div id="ContentPlaceHolder1_ctl01">
<table class="table table-striped table-bordered table-hover">
<tbody>
<tr>
<td><input name="ctl00$ContentPlaceHolder1$txtLANG1" maxlength="3" onchange="javascript:setTimeout('__doPostBack(\'ctl00$ContentPlaceHolder1$txtLANG1\',\'\')', 0)" onkeypress="if (WebForm_TextBoxKeyHandler(event) == false) return false;" id="ContentPlaceHolder1_txtLANG1" class="form-control form-filter input-sm" placeholder="LANG*" data-toggle="tooltip" data-placement="bottom" title="" required="required" data-original-title="Enter Your Language Marks Obtained" type="text"></td>
<td><input name="ctl00$ContentPlaceHolder1$txtSUB1" maxlength="3" onchange="javascript:setTimeout('__doPostBack(\'ctl00$ContentPlaceHolder1$txtSUB1\',\'\')', 0)" onkeypress="if (WebForm_TextBoxKeyHandler(event) == false) return false;" id="ContentPlaceHolder1_txtSUB1" required="required" placeholder="SUB-1*" data-placement="bottom" class="form-control form-filter input-sm" data-original-title="Enter Your Subject Marks Obtained" type="text" title="" data-toggle="tooltip"></td>
<td><input name="ctl00$ContentPlaceHolder1$txtSUB2" maxlength="3" onchange="javascript:setTimeout('__doPostBack(\'ctl00$ContentPlaceHolder1$txtSUB2\',\'\')', 0)" onkeypress="if (WebForm_TextBoxKeyHandler(event) == false) return false;" id="ContentPlaceHolder1_txtSUB2" required="required" placeholder="SUB-2*" data-placement="bottom" class="form-control form-filter input-sm" data-original-title="Enter Your Subject Marks Obtained" type="text" title="" data-toggle="tooltip"></td>
<td><input name="ctl00$ContentPlaceHolder1$txtSUB3" maxlength="3" onchange="javascript:setTimeout('__doPostBack(\'ctl00$ContentPlaceHolder1$txtSUB3\',\'\')', 0)" onkeypress="if (WebForm_TextBoxKeyHandler(event) == false) return false;" id="ContentPlaceHolder1_txtSUB3" required="required" placeholder="SUB-3*" data-placement="bottom" class="form-control form-filter input-sm" data-original-title="Enter Your Subject Marks Obtained" type="text" title="" data-toggle="tooltip"></td>
<td><input name="ctl00$ContentPlaceHolder1$txtSUB4" maxlength="3" onchange="javascript:setTimeout('__doPostBack(\'ctl00$ContentPlaceHolder1$txtSUB4\',\'\')', 0)" onkeypress="if (WebForm_TextBoxKeyHandler(event) == false) return false;" id="ContentPlaceHolder1_txtSUB4" required="required" placeholder="SUB-4*" data-placement="bottom" class="form-control form-filter input-sm" data-original-title="Enter Your Subject Marks Obtained" type="text" title="" data-toggle="tooltip"></td>
<td><input name="ctl00$ContentPlaceHolder1$txtTotalMarks" type="text" id="ContentPlaceHolder1_txtTotalMarks" disabled="disabled" class="aspNetDisabled form-control form-filter input-sm input-disabled" placeholder="Total marks*" required="required" readonly="readonly"></td>
<td><input name="ctl00$ContentPlaceHolder1$txtPersentageOfMarks" type="text" id="ContentPlaceHolder1_txtPersentageOfMarks" disabled="disabled" class="aspNetDisabled form-control form-filter input-sm input-disabled" placeholder="% Marks Obtained*" title="Enter % Of Marks" required="required" readonly="readonly"></td>
</tr>
</tbody>
</table>
</div>
<span id="lblFullMarksMsg" style="color:red;"></span> </div>
</div>
</div>
</div>
</div>
</div>
</div>
<div class="row">
<div class="col-md-12">
<div class="panel panel-blue">
<div class="panel-heading">HIGHER QUALIFICATION</div>
<div class="panel-body pan">
<div class="form-body pal">
<div class="row">
<div class="col-md-4">
<div class="form-group">
<div class="input-icon"> <i class="fa fa-book"></i>
<input name="ctl00$ContentPlaceHolder1$txtHigherQualification" type="text" id="ContentPlaceHolder1_txtHigherQualification" class="form-control" placeholder="Higher qualification if any">
</div>
</div>
</div>
</div>
</div>
</div>
</div>
</div>
</div>
<div id="div3" class="row">
<div class="col-md-12">
<div class="panel panel-blue">
<div class="panel-heading">UPLOAD DOCUMENTS</div>
<div class="panel-body pan">
<div class="form-body pal">
<div class="row">
<div class="col-md-12"> <span style="color: red; font-size: 14px;">** Maximum upload file size 200 KB (only .jpeg)</span> </div>
</div>
<hr>
<div class="row">
<div class="col-md-6">
<div class="col-md-6">
<div class="form-group mbn">
<label class="pts">Applicant photo <span style="color: red; font-size: 14px;">*</span></label>
</div>
</div>
<div class="col-md">
<div class="form-group">
<input type="file" name="ctl00$ContentPlaceHolder1$fuPhoto" id="ContentPlaceHolder1_fuPhoto" required="required" placeholder="upload image" data-placement="bottom" title="" data-original-title="Select Your Photo(Filesize must not exceed 200kb)" accept="image/jpeg, image/png" data-toggle="tooltip">
<input id="hidval1" style="display: none;" value="1" type="text">
<div id="dvPreviewPhoto"></div>
</div>
</div>
</div>
<div class="col-md-6">
<div class="col-md-6">
<div class="form-group mbn">
<label class="pts">Applicant signature <span style="color: red; font-size: 14px;">*</span></label>
</div>
</div>
<div class="col-md">
<div class="form-group">
<input type="file" name="ctl00$ContentPlaceHolder1$fuSignature" id="ContentPlaceHolder1_fuSignature" required="required" placeholder="upload signature" data-placement="bottom" title="" data-original-title="Upload Your Signature(Filesize must not exceed 200kb)" accept="image/jpeg, image/png" data-toggle="tooltip">
<input id="hidval2" value="1" style="display: none;" type="text">
<div id="dvPreviewSig"></div>
</div>
</div>
</div>
</div>
<div class="row">
<div class="col-md-6">
<div class="col-md-6">
<div class="form-group mbn">
<label class="pts">Madhyamik/Equivalent DOB Proof <span style="color: red; font-size: 14px;">*</span></label>
</div>
</div>
<div class="col-md">
<div class="form-group">
<input type="file" name="ctl00$ContentPlaceHolder1$fuAdmit" id="ContentPlaceHolder1_fuAdmit" placeholder="upload admit" data-placement="bottom" title="" data-original-title="Upload Your AdmitCard(Filesize must not exceed 200kb)" accept="image/jpeg, image/png" onchange="this.setCustomValidity(validity.valueMissing ? 'Please Upload Your Madhyamik/Equivalent Admit' : '');" data-toggle="tooltip">
<input id="hidval3" style="display: none;" value="1" type="text">
<div id="dvPreviewAdmit"></div>
</div>
</div>
</div>
<div class="col-md-6">
<div class="col-md-6">
<div class="form-group mbn">
<label class="pts">H.S/Equivalent Mark-Sheet<span style="color: red; font-size: 14px;">*</span></label>
</div>
</div>
<div class="col-md">
<div class="form-group">
<input type="file" name="ctl00$ContentPlaceHolder1$fuMarkSheet" id="ContentPlaceHolder1_fuMarkSheet" placeholder="upload mark-sheet" data-placement="bottom" title="" data-original-title="Upload Your HS MarkSheet(Filesize must not exceed 200kb)" accept="image/jpeg, image/png" onchange="this.setCustomValidity(validity.valueMissing ? 'Please Upload Your H.S. Marksheet' : '');" data-toggle="tooltip">
<input id="hidval4" style="display: none;" value="1" type="text">
<div id="dvPreviewMarkSheet"></div>
</div>
</div>
</div>
</div>
<div class="row">
<div class="col-md-6">
<div class="col-md-6">
<div class="form-group mbn">
<label id="lblCasteCertificate" class="pts">Caste/PH/In-Service certificate</label>
</div>
</div>
<div class="col-md">
<div class="form-group">
<input type="file" name="ctl00$ContentPlaceHolder1$fuCasteCertificate" id="ContentPlaceHolder1_fuCasteCertificate" placeholder="upload certificate" data-toggle="tooltip" data-placement="bottom" title="" data-original-title="Upload Your Caste Certificate(Filesize must not exceed 200kb)">
<input id="hidval6" style="display: none;" value="1" type="text">
<div id="dvPreviewCasteCertificate"></div>
</div>
</div>
</div>
<div class="col-md-6">
<div class="col-md-6">
<div class="form-group mbn">
<label id="lblExService" class="pts">Ex-Serviceman certificate <span style="color: red; font-size: 11px;">(only pdf)</span></label>
</div>
</div>
<div class="col-md">
<div class="form-group">
<input type="file" name="ctl00$ContentPlaceHolder1$fuExServiceman" id="ContentPlaceHolder1_fuExServiceman" accept="application/pdf" placeholder="upload certificate" data-toggle="tooltip" data-placement="bottom" title="" data-original-title="Ex-Serviceman Certificate Only PDF(Maximum file size 200kb)">
<input id="hidval7" style="display: none;" value="1" type="text">
<div id="dvPreviewExServiceman"></div>
</div>
</div>
</div>
</div>
</div>
</div>
</div>
</div>
</div>
<div class="row">
<div class="col-md-12">
<div class="panel panel-blue ">
<div class="panel-heading">DECLARATION</div>
<div class="panel-body pan">
<div class="form-body pal ">
<div class="row">
<div class="col-md-12">
<div style="font-size: 15px; color: #337ab7;">
<ul>
<li>I hereby
declare that i have read the information online and the information
provided by me above are true to the best of my knowledge and belief. </li>
<li>If at any stage any part of the information provided by me is found to be incorrect or untrue my candidature for the two years D.EL.Ed course will stand cancelled. I further state that in the event of any dispute arising out of any reason involving my candidature or selection for admission, the decision of the West Bengal Board of Primary Education will be final and binding upon me. </li>
</ul>
</div>
</div>
<div class="col-md-12">
<div class="form-group">
<div id="div4" class="checkbox">
<label>
<input id="chkdeclare" required="required" onchange="this.setCustomValidity(validity.valueMissing ? 'Please indicate that you agree to the above declaration' : '');" type="checkbox">
I have read and agree to the declaration</label>
</div>
</div>
</div>
<div id="divsave" class="col-md-12">
<div class="form-actions top">
<div class="col-md-offset-5 col-md-7">
<input type="submit" name="ctl00$ContentPlaceHolder1$btnSave" value="Submit" onclick="javascript:WebForm_DoPostBackWithOptions(new WebForm_PostBackOptions("ctl00$ContentPlaceHolder1$btnSave", "", true, "", "", false, false))" id="ContentPlaceHolder1_btnSave" class="btn btn-green" onsubmit="javascript:return WebForm_OnSubmit();" enctype="multipart/form-data">
<input name="btnClose" value="Close" id="btnClose" class="btn btn-primary" type="submit">
</div>
</div>
</div>
</div>
</div>
</div>
</div>
</div>
</div>
</div>
</div>
</div>
</div>
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<!-- BOOTSTRAP SCRIPTS -->
<input type="hidden" name="ctl00$ContentPlaceHolder1$hflEnrollmentNo" id="ContentPlaceHolder1_hflEnrollmentNo">
<input type="hidden" name="ctl00$ContentPlaceHolder1$hfldStudentCode" id="ContentPlaceHolder1_hfldStudentCode">
<input type="hidden" name="ctl00$ContentPlaceHolder1$hdnacademicID" id="ContentPlaceHolder1_hdnacademicID">
<input type="hidden" name="ctl00$ContentPlaceHolder1$hdnSL" id="ContentPlaceHolder1_hdnSL">
<input type="hidden" name="ctl00$ContentPlaceHolder1$hdnAdmissforPay" id="ContentPlaceHolder1_hdnAdmissforPay">
</div>
<?php include('include/footer.php');?>