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Student_Reg_form.html
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Student_Reg_form.html
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<!DOCTYPE html>
<html>
<head>
<title>Registration-Step 1</title>
<link href="https://fonts.googleapis.com/css2?family=Raleway&display=swap" rel="stylesheet">
<style id="compiled-css" type="text/css">
.main{ border-radius:30px; padding: 2% 2%; background-color: white;vertical-align: center;margin-top: 5%;margin-bottom: 5%;
box-shadow: 0 4px 8px 0 rgba(0, 0, 0, 0.2), 0 6px 20px 0 rgba(0, 0, 0, 0.19);
}
.subtable{border-style: groove; border-radius:10px; padding: 5px 5px;border-width: 1px;background-color: #F8F8FF;width: 100%}
td{text-align: left; padding: 15px}
th{text-align: center}
body{font-family: 'Raleway', sans-serif;background-image: url('./icons/back.jpg');
background-repeat: no-repeat;background-attachment: fixed;background-position: center top;}
input[type=text]{
border: 1px solid grey;
border-radius: 10px;
padding: 7px 10px;
box-sizing: border-box;
text-align: left;
align-self: center;
float: center;
width: 80%;
}
input[type=date]{
border-radius: 10px;
}
input[type=email]{
border-radius: 10px;padding: 5px 0px;width: 80%
}
input[type=submit]{background-color:#4B0082 ;color: white;border: none;padding: 10px 40px;text-align: center; border-radius: 10px ; }
input[type=submit]:hover{
background-color: green;
box-shadow: 0 4px 8px 0 rgba(0, 0, 0, 0.2), 0 6px 20px 0 rgba(0, 0, 0, 0.19);
}
</style>
<script type="text/javascript" src="./js/dropzone.js"></script>
<script src="./js/image_validate.js"></script>
</head>
<body>
<form action="./user_page/Student/Registration/registration-1.php" method="post" enctype="multipart/form-data" autocomplete="off">
<table align="center" class="main">
<tr>
<td colspan="2" style="background-color: #4B0082;border-radius: 10px"><center>
<img src="./icons/logo.png" style="width:80px;height:80px;" >
</center></td>
</tr>
<tr>
<th colspan="2" style="color: #4B0082"><h1>Online Application Form - Step 1</h1></th>
</tr>
<tr>
<td>Name with initials</td>
<td><input type="text" name="Iname" required></td>
</tr>
<tr>
<td>Full Name</td>
<td><input type="text" name="Fname" required></td>
</tr>
<tr>
<td>Birthday</td>
<td><input type="date" name="DOB" placeholder="YYYY-MM-DD" required></td>
</tr>
<tr>
<td>NIC No.</td>
<td><input type="text" name="NIC" required maxlength="12"></td>
</tr>
<tr>
<td>Address</td>
<td><input type="text" name="Address" required></td>
</tr>
<tr>
<td>District</td>
<td><input type="text" name="District" required></td>
<tr>
<tr>
<td>Province </td>
<td>
<select name="Province" style="border-radius: 10px;padding: 5px 5px">
<option value="Western">Western</option>
<option value="Northern">Northern</option>
<option value="North Central">North Central</option>
<option value="Eastern">Eastern</option>
<option value="Central">Central</option>
<option value="Sabaragamuwa">Sabaragamuwa</option>
<option value="Uva">Uva</option>
<option value="Southern">Southern</option>
<option value="North Western">North Western</option>
</select>
</td>
</tr>
<tr>
<td>Divisional Secretariat</td>
<td><input type="text" name="DS" required></td>
</tr>
<tr>
<td>Zip Code </td>
<td><input type="text" name="Zip" required></td>
</tr>
<tr>
<td>Gender</td>
<td><input type="radio" id="Male" name="Gender" value="Male"><label for="Male" style="margin-right: 50px">Male</label>
<input type="radio" id="Female" name="Gender" value="Female"><label for="Female">Female</label>
</td>
</tr>
<tr>
<td>Landline No.</td>
<td><input type="text" name="Landline" placeholder="011XXXXXXX" maxlength="10"></td>
</tr>
<tr>
<td>Mobile No.</td>
<td><input type="text" name="Mobile" placeholder="07XXXXXXXX" required maxlength="10"></td>
</tr>
<tr>
<td>Email Address</td>
<td><input type="email" name="Email" placeholder="[email protected]" required></td>
</tr>
<tr>
<td colspan="2">
<table class="subtable" >
<tr>
<td>
Upload Student Photo<br>
<i style="font-size: 12px">(please upload passport size photo &<br> rename it with your NIC number )<br> File types - jpeg , jpg , png
</i>
</td>
<td >
<input type="file" name="stu_photo" id="file" required onchange="return fileValidation()" accept=".jpg, .png, .jpeg" class="dropzone" style="border:1px dashed black;border-radius:10px;padding: 40px 40px">
</td>
</tr>
</table>
</td>
</tr>
<tr>
<td>Marital status</td>
<td><input type="radio" name="Marital" value="Single" id="Single">
<label for="Single" style="margin-right: 20px">Single</label>
<input type="radio" name="Marital" value="Married" id="Married">
<label for="Married">Married</label>
</td>
</tr>
<tr>
<td rowspan="2">Program applying for</td>
<td><input type="radio" name="Program" value="EAT" id="EAT">
<label for="EAT">BSc (External) in Electronics and Automation Technologies</label>
</td>
</tr>
<tr>
<td>
<input type="radio" name="Program" value="FA" id="FA">
<label for="FA">BSc (External) in Financial Engineering</label>
</td>
</tr>
<tr>
<td colspan="2" align="center"><center><input type="submit" name="regform" value="Submit & Processed to Payment"></center></td>
</tr>
</table>
</form>
</body>
</html>