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<title>Welcome To SGN Govt. P. G. College</title>
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	$(document).ready(function(){
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				$("#minor").html(res);
				
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	<div class="header" style="background:url(images/ch13.jpg) repeat;">
		<div class="content white">
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					<!--/.navbar-->
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<?php include('link/menu.php');?>
        
	<div class="clearfix"></div>
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<!-- /Header--> 
<!-- banner-->

<!--/banner-->
   <div class="gallery" id="gallery">
         <div class="container">
                 
       <h3>ऑनलाइन आवेदन फॉर्म  (स्नातक - विज्ञान वर्ग )</h3>
            <div class="about-bottom  w3ls-team-info">
		           
             
          <div class="col-md-12 w3ls_ar" style='background-color:#33b5e5;color:black;'><br/>
      <form class="form-horizontal" id='myform'>
	 <!--phli row open--->
	  <div class="col-sm-6">
	   
  <div class="form-group">
    <label  class="col-sm-4 control-label">Student Name<span style="color:red">*</span></label>
    <div class="col-sm-8">
      <input type="text" class="form-control" id="name" placeholder="Student Name" name="name" required style="color:black" data-validation="custom" data-validation-regexp="^([a-zA-Z\s]+)$" data-validation-error-msg="Use Only Alphabet" />
    </div>
  </div>
  <br/>
	  <div class="form-group">
    <label  class="col-sm-4 control-label">Mother Name<span style="color:red">*</span></label>
    <div class="col-sm-8">
      <input type="text" class="form-control" id="mother" placeholder="Mother Name" name="mother" required data-validation="custom" data-validation-regexp="^([a-zA-Z\s]+)$" data-validation-error-msg="Use Only Alphabet" >
    </div>
  </div>
	    <br/>
	 
	   <div class="form-group">
  
    <label  class="col-sm-4 control-label">Gender<span style="color:red">*</span></label>
    <div class="col-sm-8">
	
	<select class="form-control"  name="gender" required data-validation="required">
	<option value="">---select---</option>
	<option>Male</option>
	<option>Female</option>
	
	</select>
	</div>
	</div>
	  <br/>
	   <div class="form-group">

    <label  class="col-sm-4 control-label">Category<span style="color:red">*</span></label>
    <div class="col-sm-8">
	
	<select class="form-control"  name="category" required data-validation="required">
	<option value="">---select---</option>
	<option>GEN</option>
	<option>OBC</option>
	<option>ST</option>
	<option>SC</option>
	<option>OTHER</option>
	
	</select>
	</div>
	</div>
	<br/>
	 <div class="form-group">

    <label  class="col-sm-4 control-label">Sub Category<span style="color:red">*</span></label>
    <div class="col-sm-8">
	 <input type="text" class="form-control"  placeholder="Sub Category" name="sub_category" required data-validation="custom" data-validation-regexp="^([a-zA-Z\s]+)$" data-validation-error-msg="Use Only Alphabet">
	
	</div>
	</div><br/>
	<div class="form-group">

    <label  class="col-sm-4 control-label">Minority<span style="color:red">*</span></label>
    <div class="col-sm-8">
	
	<select class="form-control"  name="minority" required>
	<option value="">---select---</option>
	<option>No</option>
	<option>Yes</option>
	
	
	</select>
	</div>
	</div><br/>
	 <div class="form-group">
   <label  class="col-sm-4 control-label">Choose Course<span style="color:red">*</span></label>
   <div class="col-sm-8">
   
	 <select class="form-control"  name="course" id='course' required >
	<option value="">---select---</option>

	<option>B.Sc I</option>

	
	
	</select>
	  </div>
	  </div>
	    
	  
  <div class="form-group" >
  
    <label  class="col-sm-4 control-label">Select Subject A <span style="color:red">*</span></label>
    <div class="col-sm-8" >
	<select class="form-control" id="sel12" name="choose_subject1" required >
	<option value="">---select---</option>
	
	<option></option>
	
	</select>
	
	</div>
	
	 
	</div>
	 <div class="form-group" >
  
    <label  class="col-sm-4 control-label">Select Subject B <span style="color:red">*</span></label>
     <div class="col-sm-8" >
	<select class="form-control" id="sel122" name="choose_subject2" required >
	<option value="">---select---</option>
	

	
	</select>
	
	</div>
	
	 
	</div>
	 <div class="form-group" >
  
    <label  class="col-sm-4 control-label">Select Subject C <span style="color:red">*</span></label>
    <div class="col-sm-8" >
	<select class="form-control" id="sel1223" name="choose_subject3" required >
	<option value="">---select---</option>
	

	
	</select>
	
	</div>
	
	 
	</div>
	 <div class="form-group" >
  
    <label  class="col-sm-4 control-label">Skill Development<span style="color:red">*</span></label>
    <div class="col-sm-8" >
	<select class="form-control"  name="skill"  required>
	<option >Basic Computer Application</option>
		<option >Gardening</option>
			<option >Electrician</option>
				
	
	
	
	
	</select>
	
	</div>
	
	 
	</div>
	<div class="form-group" >
  
    <label  class="col-sm-4 control-label">Co-Curi. Activities<span style="color:red">*</span></label>
    <div class="col-sm-8" >
	<select class="form-control"  name="curricular"  required>
	<option >Food Nutrition and Hygiene</option>
	
				
	
	

	
	</select>
	
	</div>
	
	 
	</div>
		<div class="form-group" >
  
    <label  class="col-sm-4 control-label">Minor/Elective Paper<span style="color:red">*</span></label>
    <div class="col-sm-8" >
	<select class="form-control"  id='minor' name="minor"  required>
		
	
	
	
	
	</select>
	
	</div>
	
	 
	</div>
	   <div class="form-group">
   <label  class="col-sm-4 control-label">Staff Quota<span style="color:red"></span></label>
   <div class="col-sm-8">
   
	 <select class="form-control"  name="quota" id='quota' required >
	
	<option>No</option>
	<option>Yes</option>
	
	
	</select>
	  </div>
	  </div><br/>
	 <div class="form-group">
    <label  class="col-sm-4 control-label">Email Id<span style="color:red">*</span></label>
    <div class="col-sm-8">
      <input type="email" class="form-control" id="" data-validation="email" required placeholder="Email Id" name="email"  required />
    </div>
  </div>
	    <br/>
	  <div class="form-group">
    <label  class="col-sm-4 control-label">Annual Income<span style="color:red"></span></label>
    <div class="col-sm-8">
      <input type="number" class="form-control" id="" placeholder="Annual Income" name="income"  >
    </div>
  </div>
	    <br/>
	  	  <div class="form-group">
    <label  class="col-sm-4 control-label">Nationality<span style="color:red"></span></label>
    <div class="col-sm-8">
      <input type="text" class="form-control" id="" placeholder="Nationality" name="nationality"  >
    </div>
  </div>
	    <br/>
	  </div>
	  <!--phli row close--->
	  <!--dusri row open--->
	  <div class="col-sm-6">
	  <div class="form-group">
    <label  class="col-sm-4 control-label">Father Name<span style="color:red">*</span></label>
    <div class="col-sm-8">
      <input type="text" class="form-control" id="father" placeholder="Father Name" name="father" required data-validation="custom" data-validation-regexp="^([a-zA-Z\s]+)$" data-validation-error-msg="Use Only Alphabet">
    </div>
  </div>
    <br/>
  <div class="form-group">
    <label  class="col-sm-4 control-label">Date Of Birth<span style="color:red">*</span></label>
    <div class="col-sm-8">
      <input type="text" class="form-control" id="dob" data-validation="date" required data-validation-format="dd/mm/yyyy" data-validation-error-msg="Use Only dd/mm/yyyy format" placeholder='DD/MM/YYYY' name="dob"><span></span>
    </div>
  </div>
    <br/>
  <div class="form-group">
 
    <label  class="col-sm-4 control-label">Session <span style="color:red">*</span></label>
    <div class="col-sm-8">
	
	<select class="form-control"  name="session" data-validation="required">
	
	<option>2021-2022</option>
	
	</select>
	</div>
	</div>
	<br/>
  <div class="form-group">
    <label  class="col-sm-4 control-label">Aadhaar No.<span style="color:red">*</span></label>
    <div class="col-sm-8">
      <input type="text" class="form-control" id="father" placeholder="Adhar Number" required name="adhar" data-validation="custom" data-validation-regexp="^([0-9\s]+)$" data-validation-error-msg="Use Only Number" maxlength='12'>
    </div>
  </div><br/>
   <div class="form-group">
   <label  class="col-sm-4 control-label">NCC Certificate<span style="color:red"></span></label>
   <div class="col-sm-8">
   
	 <select class="form-control"  name="ncc" id='ncc' required >
	
	<option>No</option>
	<option>A</option>
	<option>B</option>
	<option>C</option>
	
	
	</select>
	  </div>
	  </div><br/>
	   <div class="form-group">
   <label  class="col-sm-4 control-label">NSS Certificate<span style="color:red"></span></label>
   <div class="col-sm-8">
   
	 <select class="form-control"  name="nss" id='nss' required >
	
	<option>No</option>
	<option>Yes</option>
	
	
	</select>
	  </div>
	  </div><br/>
	   <div class="form-group">
   <label  class="col-sm-4 control-label">Sport Certificate<span style="color:red"></span></label>
   <div class="col-sm-8">
   
	 <select class="form-control"  name="game" id='game' required >
	
	<option>No</option>
	<option>District Level</option>
	<option>State Level</option>
	
	
	</select>
	  </div>
	  </div><br/>
	  <div class="form-group">
   <label  class="col-sm-4 control-label">Rovers/Rangers Certificate<span style="color:red"></span></label>
   <div class="col-sm-8">
   
	 <select class="form-control"  name="rovers"  required >
	
	<option>No</option>
	<option>Yes</option>
	
	
	</select>
	  </div>
	  </div><br/>
	   <div class="form-group">
   <label  class="col-sm-4 control-label">Handicapped Certificate<span style="color:red"></span></label>
   <div class="col-sm-8">
   
	 <select class="form-control"  name="handicapped"  required >
	
	<option>No</option>
	<option>Yes</option>
	
	
	</select>
	  </div>
	  </div><br/>
	   <div class="form-group">
   <label  class="col-sm-4 control-label">EWS Certificate<span style="color:red"></span></label>
   <div class="col-sm-8">
   
	 <select class="form-control"  name="ews"  required >
	
	<option>No</option>
	<option>Yes</option>
	
	
	</select>
	  </div>
	  </div><br/>
	  	  <div class="form-group">
    <label  class="col-sm-4 control-label">Religion<span style="color:red">*</span></label>
    <div class="col-sm-8">
      <input type="text" class="form-control" id="father" placeholder="Religion" name="religion" data-validation="custom" data-validation-regexp="^([a-zA-Z\s]+)$" data-validation-error-msg="Use Only Alphabet">
    </div>
  </div>
    <br/>
	
     <div class="form-group">
   <label  class="col-sm-4 control-label">Marrital Status<span style="color:red"></span></label>
   <div class="col-sm-8">
   
	 <select class="form-control"  name="marrital"  required >
	
	<option>Unmarried</option>
	<option>Married</option>
	
	
	</select>
	  </div>
	  </div><br/>
	  <!--dusri row
	  <!--dusri row close--->
	  
	<input type="hidden" value="<?php echo strtoupper(substr(md5(uniqid()),0,30));?>" id='app1' name="app1">
			
			</div>
			
	 
	  <!-- one div-subject open--->
	  <!-- one div-subject close--->
	  
	  <!-- second div-subject open--->

	 
	
	  
	  
	  <div class="row">
	 
	
	 <div class="table table-responsive">
	 <table class="table" border="1px">
	  <th>Examination<span style="color:red">*</span></th> <th>Roll Number<span style="color:red">*</span></th><th>Board/University<span style="color:red">*</span></th><th>College/School Name<span style="color:red">*</span></th><th>Subject.<span style="color:red">*</span></th><th>Year<span style="color:red">*</span></th><th>Total Marks<span style="color:red">*</span></th><th>Obtain Marks<span style="color:red">*</span></th><th>Percentage</th><th>Regu/Priv</th><th>Grade</th>
	 </tr>
	  <tr>
	 <td><input type="text" class="form-control" style='color:black' value='10th' name="10" readonly  /></td><td><input type="number" class="form-control"  style='width:130px' name="rol_10" required /></td><td><textarea class="form-control" style='color:black' name="university" required></textarea></td><td><textarea style='color:black;width:130px;' class="form-control" name="college" required ></textarea></td><td><textarea class="form-control" style='color:black;width:130px' name="subject_pass" required></textarea></td><td><select class="form-control" name="year"  style='width:130px'required><option>2019</option><option>2018</option><option>2017</option><option>2016</option><option>2015</option><option>2014</option><option>2013</option><option>2012</option><option>2011</option></select></td><td><input type="number" class="form-control"name="tmark"  style='width:130px' id="tmark" required /></td><td><input type="number" class="form-control"  style='width:130px'name="omark" id="omark"/></td><td><input type="number" class="form-control" style='width:130px' name="per" id="per" required readonly /></td><td><select  class="form-control" style='width:130px' name='reg_10' /><option>Regular</option><option>Private</option></select></td><td><input type="text"class="form-control" style='color:black;width:130px' name="grade"></td>
	 </tr>
	 	<tr>
	 <td><input type="text" class="form-control" style='color:black' value='12th' name="12" readonly /></td><td><input type="number" class="form-control" style='width:130px'  name="rol_12" required /></td><td><textarea class="form-control" style='color:black' name="university_12"></textarea></td><td><textarea style='color:black' class="form-control" name="college_12" required></textarea></td><td><textarea class="form-control" style='color:black' name="subject_pass_12" required></textarea></td><td style='width:120px'><select class="form-control" name="year_12" required><option>2021</option><option>2020</option><option>2019</option></select></td><td><input type="number" class="form-control"name="tmark_12" id="tmark_12" required /></td><td><input type="number" class="form-control" name="omark_12" id="omark_12" required /></td><td><input type="number" class="form-control" name="per_12" id="per_12" readonly required /></td><td><select  name='reg_12'class="form-control"/><option>Regular</option><option>Private</option></select></td><td><input type="text"class="form-control"  style='color:black' name="grade_12"></td>
	 </tr>
	  <tr style='display:none'>
	 <td><input type="text" class="form-control" value='Graduation ' name="ba1" readonly /></td><td><input type="number"readonly class="form-control" value='Roll Number' name="rol_ba1" /></td><td><input type="text" class="form-control" name="university_ba1"  readonly /></td><td><input type="text" class="form-control" name="college_ba1" readonly /></td><td><input type="text" class="form-control" readonly name="subject_pass_ba1"/></td><td><input type="number" readonly class="form-control" name="year_ba1"/></td><td><input type="number" readonly class="form-control"name="tmark_ba1" id="tmark_ba1"/></td><td><input type="number" readonly class="form-control" name="omark_ba1" id="omark_ba1"  required /></td><td><input type="number" class="form-control" name="per_ba1" id="per_ba1" readonly  /></td><td><select  class="form-control" name='reg_ba1'/><option>Regular</option><option>Private</option></select></td><td><input type="text"class="form-control" readonly name="grade_ba1"></td>
	 </tr>
	  <tr style='display:none'>
	 <td><input type="text" class="form-control" value='Graduation Second' name="ba2" readonly /></td><td><input type="number"readonly class="form-control" value='Roll Number' name="rol_ba2" /></td><td><input type="text" class="form-control" name="university_ba2"  readonly /></td><td><input type="text" class="form-control" name="college_ba2" readonly /></td><td><input type="text" class="form-control" readonly name="subject_pass_ba2"/></td><td><input type="number" readonly class="form-control" name="year_ba2"/></td><td><input type="number" readonly class="form-control"name="tmark_ba2" id="tmark_ba2"/></td><td><input type="number" readonly class="form-control" name="omark_ba2" id="omark_ba2" required  /></td><td><input type="number" class="form-control" name="per_ba2" id="per_ba2" readonly  /></td><td><select  class="form-control" name='reg_ba2' /><option>Regular</option><option>Private</option></select></td><td><input type="text"class="form-control" readonly name="grade_ba2"></td>
	 </tr>
	 </table>
	 </div>
	   <hr/>
	  
	  </div>
	  <!-- second div-subject close--->
	  <input type="hidden" value="<?php echo rand(10000,99999);?>">
	  
	  <div class="col-sm-6">
	  <h4 class="text-center" style="color:black">Corresponding Address</h4>
	  <hr/>
  <div class="form-group">
    <label  class="col-sm-4 control-label">City<span style="color:red">*</span></label>
    <div class="col-sm-8">
      <input type="text" class="form-control" id="city" placeholder="city" name="city" data-validation="custom" data-validation-regexp="^([a-zA-Z\s]+)$" data-validation-error-msg="Use Only Alphabet">
    </div>
  </div>
	  <div class="form-group">
    <label  class="col-sm-4 control-label">Village<span style="color:red">*</span></label>
    <div class="col-sm-8">
      <input type="text" class="form-control" id="village" placeholder="Village" name="village" data-validation="custom" data-validation-regexp="^([a-zA-Z\s]+)$" data-validation-error-msg="Use Only Alphabet">
    </div>
  </div>
  <div class="form-group">
    <label  class="col-sm-4 control-label">Post Office<span style="color:red"></span></label>
    <div class="col-sm-8">
     <input type="text" class="form-control" id="postoffice" placeholder="Post Office" name="postoffice" data-validation="custom" data-validation-regexp="^([a-zA-Z\s]+)$" data-validation-error-msg="Use Only Alphabet">
    </div>
  </div>
	  
	   <div class="form-group">
    <label  class="col-sm-4 control-label">Dist<span style="color:red">*</span></label>
    <div class="col-sm-8">
     <input type="text" class="form-control" id="dist" placeholder="Dist" name="dist" data-validation="custom" data-validation-regexp="^([a-zA-Z\s]+)$" data-validation-error-msg="Use Only Alphabet">
    </div>
  </div>
  <div class="form-group">
    <label  class="col-sm-4 control-label">State<span style="color:red">*</span></label>
    <div class="col-sm-8">
     <input type="text" class="form-control" id="state" placeholder="State" name="state" data-validation="custom" data-validation-regexp="^([a-zA-Z\s]+)$" data-validation-error-msg="Use Only Alphabet">
    </div>
  </div>
  <div class="form-group">
    <label  class="col-sm-4 control-label">Mobile<span style="color:red"  >*</span></label>
    <div class="col-sm-8">
     <input type="text" class="form-control" id="mobile" data-validation="number"required="required" maxlength="10" name="mobile" placeholder='Mobile' data-validation-error-msg="Only Use Number" />
    </div>
  </div>
  <div class="form-group">
    <label  class="col-sm-4 control-label">Pincode</label>
    <div class="col-sm-8">
     <input type="text" class="form-control" id="pincode" placeholder="Pincode" name="pincode"  data-validation="number"required="required" maxlength="7"  data-validation-error-msg="Only Use Number" required>
    </div>
  </div>
  
	 <script>
  function readURL(input) {
  if (input.files && input.files[0]) {
    var reader = new FileReader();
    
    reader.onload = function(e) {
      $('#blah').attr('src', e.target.result);
    }
    
    reader.readAsDataURL(input.files[0]);
  }
}

$("#sign").change(function() {
  readURL(this);
});</script>
 <script>
  function readURL(input) {
  if (input.files && input.files[0]) {
    var reader = new FileReader();
    
    reader.onload = function(e) {
      $('#blah').attr('src', e.target.result);
    }
    
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$("#sign").change(function() {
  readURL(this);
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<script src="https://ajax.googleapis.com/ajax/libs/jquery/2.1.1/jquery.min.js"></script>
	  <div class="form-group">
    <label  class="col-sm-4 control-label">Picture<span style="color:red">*</span></label>
    <div class="col-sm-2">
     <img id="blah" alt="Student Picture" width="100" height="100" />

<input type="file" name="picture"  required onchange="document.getElementById('blah').src = window.URL.createObjectURL(this.files[0])">
    </div>
  </div>
	   <div class="form-group">
    <label  class="col-sm-4 control-label" style='text-align:right'>Signature<span style="color:red">*</span></label>
    <div class="col-sm-2">
     <img id="sign" alt="Student Signature" width="100" height="100" />

<input type="file" name="signature"  required onchange="document.getElementById('sign').src = window.URL.createObjectURL(this.files[0])">
    </div>
  </div>
	  </div>
	  
	   <div class="col-sm-6">
	  <h4 class="text-center" style="color:black">Personally Address</h4>
	  <hr/>
  <div class="form-group">
    <label  class="col-sm-4 control-label"><span><input type="checkbox" id="check">&nbsp;Same address&emsp;</span>City</label>
    <div class="col-sm-8">
      <input type="text" class="form-control" id="city1" placeholder="city" name="city1">
    </div>
  </div>
	  <div class="form-group">
    <label  class="col-sm-4 control-label">Village</label>
    <div class="col-sm-8">
      <input type="text" class="form-control" id="village1" placeholder="Village" name="village1">
    </div>
  </div>
  <div class="form-group">
    <label  class="col-sm-4 control-label">Post Office</label>
    <div class="col-sm-8">
     <input type="text" class="form-control" id="postoffice1" placeholder="Post Office" name="postoffice1">
    </div>
  </div>
	  
	   <div class="form-group">
    <label  class="col-sm-4 control-label">Dist</label>
    <div class="col-sm-8">
     <input type="text" class="form-control" id="dist1" placeholder="Dist" name="dist1">
    </div>
  </div>
  <div class="form-group">
    <label  class="col-sm-4 control-label">State</label>
    <div class="col-sm-8">
     <input type="text" class="form-control" id="state1" placeholder="State" name="state1">
    </div>
  </div>
  <div class="form-group">
    <label  class="col-sm-4 control-label">Mobile</label>
    <div class="col-sm-8">
     <input type="number" class="form-control" id="mobile1" placeholder="mobile" name="mobile1" >
    </div>
  </div>
  <div class="form-group">
    <label  class="col-sm-4 control-label">Pincode</label>
    <div class="col-sm-8">
     <input type="number" class="form-control" id="pincode1" placeholder="Pincode" name="pincode1">
    </div>
  </div>
  
 
  </div><br/><br/>
  <span style="margin-left:100px;font-size:17px"><input type="checkbox" id="chek"/>&emsp;I have read and agree to the <a href="#">terms and conditions.</a></span><br/>
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