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firstyear.html
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<html>
<head>
<meta name="theme-color" content="#05668D">
<meta name="viewport" content="width=device-width,initial-scale=1">
<title>IIIT DM Application Form</title>
<link rel="stylesheet" href="resources/bootstrap/bootstrap.min.css">
<link rel="stylesheet" type="text/css" href="resources/sheet.css">
<link rel="icon" href="resources/logo.png">
</head>
<body>
<div class="row">
<div class="col-md-12">
<div id="header_block">
<div id="header">Indian Institute of Information Technology <br>
Design and Maunfacturing , Kancheepuram
</div>
<br><br>
<div class="subheader">APPLICATION FORM FOR ADDMISSION TO UNDER-GRADUATE PROGRAMME</div>
<div class="subsubheader">(To be submitted by the students alloted to this Institute by CCB, JEE MAIN 2016)</div>
</div>
</div>
</div>
<div class="container">
<div class="row">
<div class="col-md-4">
<a href="/"><button class="btn btn-success">← Home</button></a>
</div>
</div>
<form action="/submit" method="post" role="form">
<div class="row">
<div class="col-lg-4 col-md-4 col-sm-6 col-xs-12" >
<div class="blank_grp">
<input type="text" id="blank1" class="blank_inp" required name="rollnumber">
<label>Roll Number</label>
</div>
</div>
<div class="col-lg-4 col-md-4 col-xs-12" >
<div class="blank_grp">
<input type="text" id="blank2" class="blank_inp" required name="regnumber">
<label>Registration Number</label>
</div>
</div>
<div class="col-lg-4 col-md-4 col-sm-6 col-xs-12" >
<div class="blank_grp">
<input type="text" id="blank3" class="blank_inp" required name="air">
<label>All India Rank</label>
</div>
</div>
<div class="col-lg-4 col-md-4 col-sm-6 col-xs-12" >
<div class="blank_grp">
<input type="text" id="blank4" class="blank_inp" required name="nationality">
<label>Nationality</label>
</div>
</div>
<div class="col-lg-4 col-md-4 col-sm-6 col-xs-12" >
<div class="blank_grp">
<input type="text" id="blank5" class="blank_inp" required name="name">
<label>Applicants Name</label>
</div>
</div>
<div class="col-lg-4 col-md-4 col-sm-6 col-xs-12" >
<div class="blank_grp">
<input type="text" id="blank7" class="blank_inp" required name="parentname">
<label>Parent / Guardian's Name</label>
</div>
</div>
</div>
<div class="row">
<div class="col-md-4 col-sm-6 col-lg-4" >
<div class="blank_grp">
<select id="select_catgy" name="catgy">
<option>General</option>
<option>SC</option>
<option>ST</option>
<option>OBC</option>
</select>
<label id="catgy">Category</label>
</div>
</div>
<div class="col-md-4 col-sm-6 col-lg-4" >
<div class="blank_grp" >
<select id="select_sex" name="sex">
<option>Male</option>
<option>Female</option>
<option>Other</option>
</select>
<label id="sex" >Sex</label>
</div>
</div>
<div class="col-md-4 col-sm-6 col-lg-4" >
<div class="blank_grp">
<div id="date">
<select class="dd_input" name="date_d">
<option value = "01">01</option>
<option value = "02">02</option>
<option value = "03">03</option>
<option value = "04">04</option>
<option value = "05">05</option>
<option value = "06">06</option>
<option value = "07">07</option>
<option value = "08">08</option>
<option value = "09">09</option>
<option value = "10">10</option>
<option value = "11">11</option>
<option value = "12">12</option>
<option value = "13">13</option>
<option value = "14">14</option>
<option value = "15">15</option>
<option value = "16">16</option>
<option value = "17">17</option>
<option value = "18">18</option>
<option value = "19">19</option>
<option value = "20">20</option>
<option value = "21">21</option>
<option value = "22">22</option>
<option value = "23">23</option>
<option value = "24">24</option>
<option value = "25">25</option>
<option value = "26">26</option>
<option value = "27">27</option>
<option value = "28">28</option>
<option value = "29">29</option>
<option value = "30">30</option>
<option value = "31">31</option>
</select>
<select class="mm_input" name="date_m" >
<option value = "January">January</option>
<option value = "February">February</option>
<option value = "March">March</option>
<option value = "April">April</option>
<option value = "May">May</option>
<option value = "June">June</option>
<option value = "July">July</option>
<option value = "August">August</option>
<option value = "September">September</option>
<option value = "October">October</option>
<option value = "November">November</option>
<option value = "December">December</option>
</select>
<select class="yy_input" name="date_y" >
<option value = "16">2016</option>
</select>
</div>
<label id="dob">Date of Birth</label>
</div>
</div>
</div>
<div class="row">
<div class="col-md-6 col-lg-6">
<div class="blank_grp">
<textarea required rows="5" cols="50" name="addr" ></textarea>
<label>Permanent Address</label>
</div>
<div class="blank_grp">
<input type="text" id="blank8" class="blank_inp" required name="city1">
<label>City</label>
</div>
<div class="blank_grp">
<input type="text" id="blank8" class="blank_inp" required name="pincode1">
<label>PIN Code</label>
</div>
<div class="blank_grp">
<input type="text" id="blank10" class="blank_inp" required name="phone1">
<label>Landline No.</label>
</div>
<div class="blank_grp">
<input type="text" id="blank11" class="blank_inp" required name="mobile1">
<label>Mobile No.</label>
</div>
</div>
<div class="col-md-6 col-lg-6">
<div class="blank_grp">
<textarea required rows="5" cols="50" name="commaddr"></textarea>
<label>Address for Communication</label>
</div>
<div class="blank_grp">
<input type="text" id="blank9" class="blank_inp" required name="city2">
<label>City</label>
</div>
<div class="blank_grp">
<input type="text" id="blank8" class="blank_inp" required name="pincode2">
<label>PIN Code</label>
</div>
<div class="blank_grp">
<input type="text" id="blank10" class="blank_inp" required name="phone2">
<label>Landline No.</label>
</div>
<div class="blank_grp">
<input type="text" id="blank11" class="blank_inp" required name="mobile2">
<label>Mobile No.</label>
</div>
</div>
</div>
<div class="row">
<div class="col-md-offset-4 col-md-4 col-sm-12 col-lg-4">
<div class="blank_grp">
<input type="text" id="blank11" class="blank_inp" required name="email">
<label>Email Address</label>
</div>
</div>
<div class="col-md-offset-4 col-xs-offset-4 col-lg-offset-4 col-md-4 col-sm-12">
<div class="row">
<div class="col-md-4 col-sm-4 col-md-offset-4">
<button class="btn btn-success" type="submit">Submit</button>
</div>
</div>
</div>
</div>
</form>
<br><br>
<div class="row">
<div class="col-sm-12 col-xs-offset-2 col-md-4 col-md-offset-4 col-lg-4 col-lg-offset-4">
Made by <b>Vedant Bassi</b> for <b>IIIT D&M Kancheepuram</b><br><br>
</div>
</div>
</div>
<script src="resources/jquery/jquery.min.js"></script>
<script src="resources/bootstrap/bootstrap.min.js"></script>
</body>
</html>