Your IP : 216.73.216.40
<?php
include "header.inc";
//$tbl = 'tbl_registration';
$id = $_REQUEST["id"];
$dob1 = $_REQUEST["dob1"];
$regid = $_REQUEST["regid"];
$remoteip = $_SERVER["REMOTE_ADDR"];
if ($id && $_REQUEST["edit"] == 1) {
include "findindex.php";
} else if ($_POST["submit"] == "FIND") {
header("Location: appformreprint.php?id=$id&dob=$dob1");
// echo "Location: appformreprint.php?id=$id&dob=$dob1";
}
if ($_POST["submit"] == "SAVE") {
$msg = "";
$fullname = $_POST["fullname"];
if (!$fullname) $msg = "Please enter your name";
$dob = $_POST["dob"];
if (!$dob) $msg = "Please enter your correct date of birth";
$gender = $_POST["gender"];
if (!$gender) $gender = 'Male';
$nationality = $_POST["nationality"];
if (!$nationality) $msg = "Please enter your nationality";
$category = $_POST["category"];
if (!$category) $category = 'GE';
$fathername = $_POST["fathername"];
if (!$fathername) $msg = "Please enter your father name";
$mothername = $_POST["mothername"];
if (!$mothername) $msg = "Please enter your mother name";
$address = $_POST["address"];
if (!$address) $msg = "Please enter your address";
$state = $_POST["state"];
$pincode = $_POST["pincode"];
if (!$pincode) $msg = "Please enter pin code";
$phone = $_POST["phone"];
$fax = $_POST["fax"];
$email = $_POST["email"];
$txntype = $_POST["txntype"];
$txnnumber = $_POST["txnnumber"];
if (!$txnnumber) $msg = "Please enter the DD/Cash Receipt No.";
$amount = $_POST["amount"];
if (!$amount) $amount = "1000";
$depositdate = $_POST["depositdate"];
//if (!$depositdate || $depositdate == '0000-00-00 00:00:00') $depositdate = date('y-m-d');//date('Y-m-d');
$bankbranch = $_POST["bankbranch"];
$discipline12 = $_POST["discipline12"];
$board12 = $_POST["board12"];
$year12 = $_POST["year12"];
$percentage12 = $_POST["percentage12"];
$appearing12 = $_POST["appearing12"];
$discipline10 = $_POST["discipline10"];
$board10 = $_POST["board10"];
$year10 = $_POST["year10"];
$percentage10 = $_POST["percentage10"];
$appearing10 = $_POST["appearing10"];
$photo = $_FILES["photo"];
if ($msg) {
echo "<center><font size=4px color='red'>$msg</font></center>";
} else {
if (mysql_num_rows(mysql_query("select * from $tbl where id=$id"))) {
mysql_query("update $tbl set fullname='$fullname',
dob='$dob', gender='$gender', nationality='$nationality', category='$category', fathername='$fathername',
mothername='$mothername', address='$address', state='$state', pincode='$pincode', phone='$phone', fax='$fax', email='$email',
txntype='$txntype', txnnumber='$txnnumber', amount='$amount', depositdate='$depositdate', bankbranch='$bankbranch',
discipline12='$discipline12', board12='$board12', year12='$year12', percentage12='$percentage12', appearing12='$appearing12',
discipline10='$discipline10', board10='$board10', year10='$year10', percentage10='$percentage10', appearing10='$appearing10',
date_modification=now(), remoteip='$remoteip' where id=$id");
} else {
mysql_query("insert into $tbl(fullname,dob,gender,nationality,category,fathername,mothername,address,state,pincode,
phone,fax,email,txntype,txnnumber,amount,depositdate,bankbranch,discipline12,board12,year12,percentage12,appearing12,
discipline10,board10,year10,percentage10,appearing10,status,date_creation,date_modification,remoteip)
values('$fullname','$dob','$gender','$nationality','$category','$fathername','$mothername','$address','$state','$pincode',
'$phone','$fax','$email','$txntype','$txnnumber','$amount','$depositdate','$bankbranch','$discipline12','$board12','$year12',
'$percentage12','$appearing12','$discipline10','$board10','$year10','$percentage10','$appearing10',
'Pending',now(),now(),'$remoteip')");
$id = mysql_insert_id();
}
if ($photo) {
$photo = upload_file($id);
mysql_query("update $tbl set photo='$photo' where id=$id");
}
header("Location: appform.php?id=$id");
}
}
echo "<input type='hidden' name='id' value='$id'>
<table width='100%'>
<tr><td>
<table>
<tr><td width=20%>Full Name </td><td width=80%> <input type='text' onkeypress='return isCharacterKey(event)' name='fullname' size='50' maxlength='50' value='$fullname'></td></tr>
<tr><td>Date of Birth</td><td><input type='text' onkeypress='return isDateKey(event)' name='dob' size='25' maxlength='25' value='$dob'> (DD/MM/YYYY)";
/*$myCalendar = new tc_calendar("dob", true, false);
if ($dob) {
$yr = date("Y",strtotime($dob));
$mth = date("m",strtotime($dob));
$dt = date("d",strtotime($dob));
$myCalendar->setDate($dt, $mth, $yr);
}
$myCalendar->setIcon("images/calendar.gif");
$myCalendar->setPath("classes/");
$myCalendar->setYearInterval(1970, 1999);
$myCalendar->dateAllow('1970-01-01', '1999-12-31');
$myCalendar->setDateFormat('j F Y');
output the calendar
$myCalendar->writeScript();
*/
echo "</td></tr>
<tr><td>Gender </td><td>";
$genders = array("Male","Female");
foreach ($genders as $gen) {
echo "<input type='radio' name='gender' value='$gen'";
if ($gen == $gender) echo " checked";
echo "> $gen ";
}
echo "
</td></tr>
<tr><td>Nationality</td><td><input type='text' onkeypress='return isCharacterKey(event)' name='nationality' size='50' maxlength='150' value='$nationality'></td></tr>
<tr><td valign='top'>Category</td><td>";
$categories = array("GE","OBC","SC","ST","PD","MN");
foreach ($categories as $cat) {
echo "<input type='radio' name='category' value='$cat'";
if ($cat == $category) echo " checked";
echo "/> $cat ";
}
echo "<br>(GE=General, OBC=Other Backward Class, SC=Schedule Cast, <br>
ST=Schedule Tribe, PD=Physically Disabled, MN=Minority )
</td></tr>
<tr><td>Father Name</td><td><input type='text' onkeypress='return isCharacterKey(event)' name='fathername' size='50' maxlength='150' value='$fathername'></td></tr>
<tr><td>Mother Name</td><td><input type='text' onkeypress='return isCharacterKey(event)' name='mothername' size='50' maxlength='150' value='$mothername'></td></tr>
<tr><td>Address for Correspondance</td><td><textarea name='address' rows='3' cols='50' maxlength='150' value='$address' >$address</textarea></td></tr>
<tr><td>State</td><td>
<select name='state'>";
$states = array('Andaman & Nicobar','Andhra Pradesh','Arunachal Pradesh','Assam','Bihar','Chandigarh',
'Chhattisgarh','Dadra & Nagar Haveli','Lakshadweep','Madhya Pradesh','Maharashtra','Manipur','Meghalaya','Mizoram',
'Nagaland','New Delhi','Orissa','Daman & Diu','Delhi','Goa','Gujarat','Haryana','Himachal Pradesh','Jammu & Kashmir',
'Jharkhand','Karnataka','Kerala','Puducherry','Punjab','Rajasthan','Sikkim','Tamil Nadu','Tripura',
'Uttar Pradesh','Uttarakhand','West Bengal');
foreach ($states as $stat) {
echo "<option value='$stat'";
if ($stat == $state) echo " selected";
echo ">$stat</option>";
}
echo "</select>
</td></tr>
<tr><td>Pin Code </td><td> <input type='text' onkeypress='return isNumberKey(event)' name='pincode' size='10' maxlength='6' value='$pincode'>
</td></tr><tr><td>Contact No. </td><td> <input type='text' name='phone' size='50' maxlength='50' value='$phone'>
</td></tr><tr><td>Fax No. </td><td> <input type='text' name='fax' size='50' maxlength='50' value='$fax'>
</td></tr><tr><td>Email Address </td><td> <input type='text' name='email' size='50' maxlength='50' value='$email'>
</td></tr>
</table>
</td><td valign=top>
";
if (!$photo){
echo "<img src='images/user_thumb_large.jpg' height=100 width=100 /><br>";}
else{
echo "<img src='photos/$id.jpg' height=100 width=100 /><br>";}
echo"Upload your photograph <sup>*</sup> (.jpg file only)<br>
<input type='file' name='photo' size='30' value='$photo' /> <br><br>
<hr>
<table>
<tr><td colspan=2><b>To Edit/Reprint your submitted application find it by</b></td></tr>
<tr><td>Application No.</td>
<td><input type='text' onkeypress='return isNumberKey(event)' name='id' size='15' maxlength='35' value='$id'></td>
</tr>
<tr><td>Date of Birth (DD/MM/YYYY)</td>
<td><input type='text' onkeypress='return isDateKey(event)' name='dob1' size='15' maxlength='35' value='$dob1'>
<input type='submit' name='submit' value='FIND'></td>
</tr>
</table>
<h4><a href='Biomedical_Engg_Broucher_2012.pdf'>Click here to download Information Brochure</a>
<img src='images/download.png' height=25 width=25> </h4>
<h4><a href='pagination.php'>Click here to see your Received Application Status</a></h4>
<!-- <h4><a href='receivedapp.php'>Click here to see Online Received Application</a></h4> -->
</td></tr>
<tr><td colspan=2><hr>
<b>Application Fee</b><br>
Click the option below for application fee submission
</td></tr>
<tr><td>
<table>
<tr><td><input type='radio' name='txntype' value='DD' checked /> DD
<input type='radio' name='txntype' value='Cash Receipt' /> Cash Receipt
</td></tr>
<tr><td>Amount Rs.</td><td>
<select name='amount'>",
$amounts = array('1000','500');
foreach ($amounts as $amt){
echo "<option value='$amt'";
if ($amt == $amount) echo " selected";
echo ">$amt</option>";
}
echo "</select>
</td></tr>
<tr><td>DD No./Cash Receipt No.</td><td><input type='text' name='txnnumber' size='15' maxlength='25' value='$txnnumber'></td></tr>
<tr><td>Dated</td><td><input type='text' onkeypress='return isDateKey(event)' name='depositdate' size='25' maxlength='25' value='$depositdate'> (DD/MM/YYYY)";
/* $myCalendar = new tc_calendar("depositdate", true, false);
if ($depositdate) {
$yr = date("Y",strtotime($depositdate));
$mth = date("m",strtotime($depositdate));
$dt = date("d",strtotime($depositdate));
$myCalendar->setDate($dt, $mth, $yr);
}
$myCalendar->setIcon("images/calendar.gif");
$myCalendar->setPath("classes/");
$myCalendar->setYearInterval(2012, 2012);
$myCalendar->dateAllow('2012-01-01', '2012-04-30');
$myCalendar->setDateFormat('j F Y');
//output the calendar
$myCalendar->writeScript();
*/
echo "</td></tr>
<tr><td>Bank & Branch Name</td><td><input type='text' name='bankbranch' size='50' maxlength='150' value='$bankbranch'></td></tr>
</table>
</td></tr>
<tr><td colspan=2>
<hr>
<b>Details of Qualifying Examination (*) passed or likely to be passed</b>
</td></tr>
<tr><td colspan=2>
<table border=1>
<tr><td>Name of the Qualifying <br>Examination<br> Passed/Appearing</td>
<td>Discipline</td>
<td>Board</td>
<td>Year of<br> Passing/Appearing</td>
<td>Percentage of Marks<br> Obtained</td>
<td>Final Result Expected by<br> (If Appearing)</td></tr>
<tr><td><b>Class XII</b></td>
<td><input type='text' name='discipline12' size='20' maxlength='20' value='$discipline12'> </td>
<td><input type='text' name='board12' size='25' maxlength='50' value='$board12'></td>
<td><input type='text' name='year12' size='25' maxlength='50' value='$year12'></td>
<td><input type='text' name='percentage12' size='25' maxlength='50' value='$percentage12'></td>
<td><input type='text' name='appearing12' size='25' maxlength='50' value='$appearing12'></td>
</tr>
<tr><td><b>Class X</b></td>
<td><input type='text' name='discipline10' size='20' maxlength='20' value='$discipline10'> </td>
<td><input type='text' name='board10' size='25' maxlength='50' value='$board10'></td>
<td><input type='text' name='year10' size='25' maxlength='50' value='$year10'></td>
<td><input type='text' name='percentage10' size='25' maxlength='50' value='$percentage10'></td>
<td><input type='text' name='appearing10' size='25' maxlength='50' value='$appearing10'></td>
</tr>
</table>
</td></tr>
<tr><td><br>
<input type='submit' name='submit' value='SAVE'>";
echo "</td></tr></table>
";
?>
<br>
<b>After filling online registration form please take a printout of your submitted registration details and keep the registration no. for further communication. </b><br>
* Scanned copy of Photograph can be uploaded on the online application form.<br>
# Attach attested copies of certificates, marks sheet etc. See information brochure for certificates required.<br>
<?php
include "footer.inc";
?>