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Server : Apache System : Linux profile 3.10.0-1160.88.1.el7.x86_64 #1 SMP Tue Mar 7 15:41:52 UTC 2023 x86_64 User : apache ( 48) PHP Version : 8.0.28 Disable Function : NONE Directory : /var/www/html/mmishra/indem/webbioexam/biomedical/ |
<table><tr><td colspan=2 align=center><h2>Indian Institute of Information Technology Allahabad</h2></td></tr>
<tr><td width=20% align=center><img src="logo.gif" width="75" height="78" /></td>
<td width=80% align=center>
(A University under Section 3 0f UGC Act 1956)<br>
A Centre of Excellence in Information Technology, Estd. By Min. of HRD, Govt. of India, New Delhi<br>
Devghat Jhalwa, Allahabad – 211012, U.P. (INDIA)<br>
Ph: 0532-2922025,2922067 Fax: 0532-2922081 <br>
Web: <a href="http://www.iiita.ac.in/">www.iiita.ac.in</a> Email: <a href="mailto:mtech@iiita.ac.in">mtech@iiita.ac.in</a>
</td></tr>
<tr><td colspan=2><hr><center><h3>Online Applicantion Form For M. Tech. 2012-2013 </h3></center></td></tr>
</table>
<form method="post">
<?php
include "javafunctions.inc";
include "functions.inc";
dbConnect();
$tbl = 'tbl_registration';
$id = $_REQUEST["id"];
$regid = $_REQUEST["regid"];
$dob1 = $_REQUEST["dob1"];
if ($id && $dob1) {
$rs = mysql_query("select * from $tbl where id='$id' and dob='$dob1'");
if (!$rs) {
echo "<b><font color='red'>Sorry! your details not available in the database.</font></b>";
}else{
$o = mysql_fetch_object($rs);
$regid = $o->regid;
$fullname = $o->fullname;
$dob = $o->dob;
$pob = $o->pob;
$gender = $o->gender;
$nationality = $o->nationality;
$fathername = $o->fathername;
$address = $o->address;
$state = $o->state;
$pincode = $o->pincode;
$phone = $o->phone;
$fax = $o->fax;
$email = $o->email;
$txntype = $o->txntype;
$txnnumber = $o->txnnumber;
$amount = $o->amount;
$depositdate = $o->depositdate;
$bankbranch = $o->bankbranch;
$stream = $o->stream;
$bi = $o->bi;
$hci = $o->hci;
$ins = $o->ins;
$mi = $o->mi;
$ro = $o->ro;
$se = $o->se;
$wcc = $o->wcc;
$ce = $o->ce;
$category = $o->category;
$ge_name = $o->ge_name;
$ge_discipline = $o->ge_discipline;
$ge_rank = $o->ge_rank;
$ge_year = $o->ge_year;
$qd_university = $o->qd_university;
$qd_discipline = $o->qd_discipline;
$qd_degree = $o->qd_degree;
$qd_examdate = $o->qd_examdate;
$qd_finalresultexpectedby = $o->qd_finalresultexpectedby;
$qd_minmarks = $o->qd_minmarks;
$qd_overallgrade = $o->qd_overallgrade;
$we_datefrom1 = $o->we_datefrom1;
$we_dateto1 = $o->we_dateto1;
$we_employer1 = $o->we_employer1;
$we_position1 = $o->we_position1;
$we_nature1 = $o->we_nature1;
$we_datefrom2 = $o->we_datefrom2;
$we_dateto2 = $o->we_dateto2;
$we_employer2 = $o->we_employer2;
$we_position2 = $o->we_position2;
$we_nature2 = $o->we_nature2;
$we_datefrom3 = $o->we_datefrom3;
$we_dateto3 = $o->we_dateto3;
$we_employer3 = $o->we_employer3;
$we_position3 = $o->we_position3;
$we_nature3 = $o->we_nature3;
$photo = $o->photo;
$app_status = $o->app_status;
//}
//}
echo "
<table>
<tr><td valign=top>
<table>
<tr><td width=20%>Full Name </td><td width=80%> ".ucwords($fullname)." </td></tr>
<tr><td>Date of Birth </td><td> ".$dob." </td></tr>
<tr><td>Place of Birth </td><td> ".ucwords($pob)." </td></tr>
<tr><td>Gender </td><td> ".ucwords($gender)." </td></tr>
<tr><td>Nationality </td><td> ".ucwords($nationality)." </td></tr>
<tr><td>Father Name </td><td> ".ucwords($fathername)." </td></tr>
<tr><td>Address for Correspondance </td><td> ".ucwords($address)." </td></tr>
<tr><td>State </td><td> ".ucwords($state)." </td></tr>
<tr><td>Pin Code </td><td> ".$pincode." </td></tr>
<tr><td>Contact No. </td><td> ".$phone." </td></tr>
<tr><td>FAX No. </td><td> ".$fax." </td></tr>
<tr><td>Email Address </td><td> ".$email." </td></tr>
</table>
</td> <td valign=top align=center nowrap><br>
<b>Reg. No. : ".$regid."</b><br><br>";
if (!$photo) {
echo "<img src='photos/demo.jpg' height=150 width=130 /> <br><br>";
} else {
echo "<img src='$photo' height=150 width=130 /> <br><br>";
}
echo "
<input type='text' size=20 /><br>
Signature of Candidate
</td></tr>
<tr><td colspan=2><hr>
<b>Application Fee Details </b><br>
</td></tr><tr><td colspan=2>
<table width=100%>
<tr><td>".$txntype."</td>
<td>Number ".$txnnumber."</td>
<td>Amount Rs. ".$amount."</td>
<td>Dated ".$depositdate."</td>
</tr>
<tr><td colspan=4>Bank & Branch issued ".ucwords($bankbranch)."
</td></tr>
</table>
<hr>
</td></tr>
<tr><td colspan=2> Stream: ".ucwords($stream)."
<br>
Preference: BI=".$bi.", HCI=".$hci.", IS=".$ins.", RO=".$ro.", SE=".$se.", MI=".$mi.", WCC=".$wcc.", CE=".$ce."
(Missing preference values does not apply)
</td></tr><tr><td>Category: ";
switch ($category){
case "GE";
echo "General";
break;
case "SC";
echo "Scheduled Cast";
break;
case "ST";
echo "Scheduled Tribe";
break;
case "PH";
echo "Physically Handicapped";
break;
case "SN";
echo "Sponsored";
break;
case "NR";
echo "Non-Resident Indian";
break;
case "OB";
echo "Other Backward Classes";
break;
}
echo "</td></tr>
<tr><td colspan=2>
<b>GATE exam details<sup>#</sup> Not for MBBS/BVSc & AH/Sponsored candidates. GRE details for NRI/FN Candidates.</b>
</td></tr>
<tr><td colspan=2>
<table border=1 width=100%>
<tr><td>Exam Name </td>
<td>Exam Discipline </td>
<td>Exam Year </td>
<td>Rank/Score </td>
</tr>
<tr><td>".ucwords($ge_name)."</td>
<td>".ucwords($ge_discipline)."</td>
<td>".$ge_year."</td>
<td>".$ge_rank."</td>
</tr>
</table>
</td></tr>
<tr><td colspan=2>
<b>Qualifying Degree<sup>#</sup> already obtained or in progress</b>
</td></tr>
<tr><td colspan=2>
<table border=1 width=100%>
<tr><td>University/Institute</td>
<td>Discipline</td>
<td>Degree</td>
<td>Exam Date</td>
<td>Final results expected by <br> (if degree not completed)</td>
<td>Min. Pass Marks, % or <br>Grade Average</td>
<td>Overall % or Grade Average<br> (if degree completed)</td>
</tr>
<tr><td>".ucwords($qd_university)."</td>
<td>".ucwords($qd_discipline)."</td>
<td>".ucwords($qd_degree)."</td>
<td>".$qd_examdate."</td>
<td>".$qd_finalresultexpectedby."</td>
<td>".$qd_minmarks."</td>
<td>".$qd_overallgrade." </td>
</tr>
</table>
</td></tr>
<tr><td colspan=2>
<b>Working Experience<sup>*</sup> (if applicable latest three only)</b>
</td></tr><tr><td colspan=2>
<table border=1 width=100%>
<tr><td colspan=2 align='center'>Dates (From -To)</td><td>Employer</td><td>Position</td><td>Nature of Work</td></tr>
<tr><td>".$we_datefrom1."</td>
<td>".$we_dateto1."</td>
<td>".ucwords($we_employer1)."</td>
<td>".ucwords($we_position1)."</td>
<td>".ucwords($we_nature1)."</td>
</tr>
<tr><td>".$we_datefrom2."</td>
<td>".$we_dateto2."</td>
<td>".ucwords($we_employer2)."</td>
<td>".ucwords($we_position2)."</td>
<td>".ucwords($we_nature2)."</td>
</tr>
<tr><td>".$we_datefrom3."</td>
<td>".$we_dateto3."</td>
<td>".ucwords($we_employer3)."</td>
<td>".ucwords($we_position3)."</td>
<td>".ucwords($we_nature3)."</td>
</tr>
</table>
</td></tr>
</table>
";
echo"
<br>
<b>Declaration by the applicant:</b>
<p align='justify'>Certified that all information provided by me in this form is correct to the best of my knowledge and belief. I understand that any willful misrepresentation of facts will result in my admission being cancelled/dismissal from the Institute. If admitted, I shall abide by all the rules and regulations of the Institute.</p>
Date: ... ... ... ... ... ...
Signature of Candidate: ... ... ... ... ... ...
<br><br>
Place: ... ... ... ... ... ...
<br><br></td></tr>
<b>Declaration by Parent/Guardian (Not to be filled by sponsored candidates)</b>
<p align='justify'>In the event of Mr./Ms. ... ... ... ... ... ... ... ... ... ... ... ... ... son/daughter/ward being admitted, I hereby give an undertaking to pay regularly all admissible dues to the Institute and Hostel till the completion of his/her studies. I undertake the responsibility for his/her good conduct. I am also aware that RAGGING is prohibited at the Institute and is treated as a cognizable offence at IIIT-Allahabad, under the Indian Penal Code and the directions of Hon'ble Supreme court of India and will ensure that he/she will not be involved in any ragging related activity.</p>
Date: ... ... ... ... ... ...
Signature of Parent/Guardian: ... ... ... ... ... ...
<br><br>
Place: ... ... ... ... ... ...
<br>
<br><hr>
# Attach attested copies of certificates, marks sheet etc.<br>
* A candidate presenetly working (including those on projects) must provide a "No Objection / Relieving certificate" from the employer.<br>
<hr>
<center>
<input type='button' value='Print' onclick='printpage()' />
</center>
</form>";
?>