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Admission Form 2016-17
<div><br></div><div><table width="980" border="0" align="center" cellpadding="0" cellspacing="0" style="color: rgb(51, 51, 51); font-family: Arial, Helvetica, sans-serif; line-height: normal;"><tbody><tr><td valign="top" bgcolor="#FFFFFF" scope="col" height="6"></td></tr><tr><td valign="top" bgcolor="#FFFFFF"> </td><td valign="top" bgcolor="#FFFFFF"><center><table style="width: 864px;"><tbody><tr><td><center><fieldset class="formular" style="margin-bottom: 20px; border: 1px solid rgb(181, 184, 200); padding: 15px;"><legend class="formular" style="color: rgb(20, 102, 124); font-size: 15px; font-weight: bold; padding-right: 5px; padding-left: 5px; border-bottom-width: 0px !important; margin: 0px !important; width: auto !important;">Student Information</legend><table class="table table-style" style="width: 822px; border-spacing: 1px; border-collapse: separate; background-color: rgb(247, 247, 247);"><tbody><tr><td class="tar" style="line-height: 20px; padding-top: 5px; padding-bottom: 5px; width: 250px; text-align: right !important; background-color: rgb(255, 255, 255);"><label class="required" for="af_first_name" style="padding-right: 10px; background-image: url("../images/required-field.png"); background-position: 100% 0%; background-repeat: no-repeat;">First Name</label></td><td style="line-height: 20px; padding-top: 5px; padding-bottom: 5px; background-color: rgb(255, 255, 255);"><label>:</label></td><td style="line-height: 20px; padding-top: 5px; padding-bottom: 5px; width: 230px; background-color: rgb(255, 255, 255);"><input type="text" class="form-control validate[required]" id="af_first_name" name="af_first_name" value="" style="border-radius: 3px; color: rgb(85, 85, 85); font-size: 12px; height: auto; line-height: 18px; padding: 3px; transition-duration: 0.15s, 0.15s; transition-delay: 0s, 0s; vertical-align: middle; width: 214px; background-image: none;"></td><td class="tar" style="line-height: 20px; padding-top: 5px; padding-bottom: 5px; text-align: right !important; background-color: rgb(255, 255, 255);"><label class="required" for="af_last_name" style="padding-right: 10px; background-image: url("../images/required-field.png"); background-position: 100% 0%; background-repeat: no-repeat;">Last Name</label></td><td style="line-height: 20px; padding-top: 5px; padding-bottom: 5px; background-color: rgb(255, 255, 255);"><label>:</label></td><td style="line-height: 20px; padding-top: 5px; padding-bottom: 5px; background-color: rgb(255, 255, 255);"><input type="text" class="form-control validate[required]" id="af_last_name" name="af_last_name" value="" style="border-radius: 3px; color: rgb(85, 85, 85); font-size: 12px; height: auto; line-height: 18px; padding: 3px; transition-duration: 0.15s, 0.15s; transition-delay: 0s, 0s; vertical-align: middle; width: 153px; background-image: none;"></td></tr><tr><td class="tar" style="line-height: 20px; padding-top: 5px; padding-bottom: 5px; text-align: right !important;"><label class="required" for="af_dob" style="padding-right: 10px; background-image: url("../images/required-field.png"); background-position: 100% 0%; background-repeat: no-repeat;">Date of Birth</label></td><td style="line-height: 20px; padding-top: 5px; padding-bottom: 5px;"><label>:</label></td><td style="line-height: 20px; padding-top: 5px; padding-bottom: 5px;"><input type="text" class="form-control validate[required] datepicker hasDatepicker" id="af_dob" name="af_dob" value="" style="border-radius: 3px; color: rgb(85, 85, 85); font-size: 12px; height: auto; line-height: 18px; padding: 3px; transition-duration: 0.15s, 0.15s; transition-delay: 0s, 0s; vertical-align: middle; width: 100px; background-image: none;"><img class="ui-datepicker-trigger" src="http://www.shivjyoti.org/manager/jquery.calendar/custom/images/calendar.png" alt="..." title="..."></td><td class="tar" style="line-height: 20px; padding-top: 5px; padding-bottom: 5px; text-align: right !important;"><label class="required" for="" style="padding-right: 10px; background-image: url("../images/required-field.png"); background-position: 100% 0%; background-repeat: no-repeat;">Gender</label></td><td style="line-height: 20px; padding-top: 5px; padding-bottom: 5px;"><label>:</label></td><td style="line-height: 20px; padding-top: 5px; padding-bottom: 5px;"><input checked="checked" type="radio" name="af_gender" id="af_gender_1" value="1" style="margin-top: 0px;"> <label for="af_gender_1">Male</label> <input type="radio" name="af_gender" id="af_gender_2" value="2" style="margin-top: 0px;"> <label for="af_gender_2">Female</label> </td></tr><tr><td class="tar" style="line-height: 20px; padding-top: 5px; padding-bottom: 5px; text-align: right !important; background-color: rgb(255, 255, 255);"><label class="required" for="" style="padding-right: 10px; background-image: url("../images/required-field.png"); background-position: 100% 0%; background-repeat: no-repeat;">Nationality</label></td><td style="line-height: 20px; padding-top: 5px; padding-bottom: 5px; background-color: rgb(255, 255, 255);"><label>:</label></td><td style="line-height: 20px; padding-top: 5px; padding-bottom: 5px; background-color: rgb(255, 255, 255);"><input checked="checked" type="radio" name="af_nationality" id="af_nationality_1" value="1" style="margin-top: 0px;"> <label for="af_nationality_1">Indian</label> <input type="radio" name="af_nationality" id="af_nationality_2" value="2" style="margin-top: 0px;"> <label for="af_nationality_2">Other</label> </td><td class="tar" style="line-height: 20px; padding-top: 5px; padding-bottom: 5px; text-align: right !important; background-color: rgb(255, 255, 255);"><label class="" for="af_nationality_other">Other Specify Here</label></td><td style="line-height: 20px; padding-top: 5px; padding-bottom: 5px; background-color: rgb(255, 255, 255);"><label>:</label></td><td style="line-height: 20px; padding-top: 5px; padding-bottom: 5px; background-color: rgb(255, 255, 255);"><input type="text" class="form-control" id="af_nationality_other" name="af_nationality_other" value="" style="border-radius: 3px; color: rgb(85, 85, 85); font-size: 12px; height: auto; line-height: 18px; padding: 3px; transition-duration: 0.15s, 0.15s; transition-delay: 0s, 0s; vertical-align: middle; width: 153px; background-image: none;"></td></tr><tr><td class="tar" style="line-height: 20px; padding-top: 5px; padding-bottom: 5px; text-align: right !important;"><label class="required" for="af_category" style="padding-right: 10px; background-image: url("../images/required-field.png"); background-position: 100% 0%; background-repeat: no-repeat;">Category</label></td><td style="line-height: 20px; padding-top: 5px; padding-bottom: 5px;"><label>:</label></td><td style="line-height: 20px; padding-top: 5px; padding-bottom: 5px;"><select class="form-control validate[required]" id="af_category" name="af_category" style="border-radius: 3px; color: rgb(85, 85, 85); font-size: 12px; height: auto; line-height: 18px; padding: 3px; transition-delay: 0s, 0s; vertical-align: middle; width: 214px; background-image: none;"> <option value="">--Select--</option> <option value="1">SC</option> <option value="2">ST</option> <option value="3">OBC</option> <option value="4">GEN</option> <option value="5">Other</option> </select></td><td class="tar" style="line-height: 20px; padding-top: 5px; padding-bottom: 5px; text-align: right !important;"><label class="" for="af_category_other">Other Specify Here</label></td><td style="line-height: 20px; padding-top: 5px; padding-bottom: 5px;"><label>:</label></td><td style="line-height: 20px; padding-top: 5px; padding-bottom: 5px;"><input type="text" class="form-control" id="af_category_other" name="af_category_other" value="" style="border-radius: 3px; color: rgb(85, 85, 85); font-size: 12px; height: auto; line-height: 18px; padding: 3px; transition-duration: 0.15s, 0.15s; transition-delay: 0s, 0s; vertical-align: middle; width: 153px; background-image: none;"></td></tr><tr><td class="tar" style="line-height: 20px; padding-top: 5px; padding-bottom: 5px; text-align: right !important; background-color: rgb(255, 255, 255);"><label class="required" for="af_class" style="padding-right: 10px; background-image: url("../images/required-field.png"); background-position: 100% 0%; background-repeat: no-repeat;">Applying For Class</label></td><td style="line-height: 20px; padding-top: 5px; padding-bottom: 5px; background-color: rgb(255, 255, 255);"><label>:</label></td><td style="line-height: 20px; padding-top: 5px; padding-bottom: 5px; background-color: rgb(255, 255, 255);"><select class="form-control validate[required]" id="af_class" name="af_class" style="border-radius: 3px; color: rgb(85, 85, 85); font-size: 12px; height: auto; line-height: 18px; padding: 3px; transition-delay: 0s, 0s; vertical-align: middle; width: 214px; background-image: none;"> <option value="">--Select--</option> <option value="1">Playgroup</option> <option value="2">Nursary</option> <option value="3">LKG</option> <option value="4">UKG</option> <option value="5">1st</option> <option value="6">2nd</option> <option value="7">3rd</option> <option value="8">4th</option> <option value="9">5th</option> <option value="10">6th</option> <option value="11">8th</option> <option value="12">9th</option> <option value="13">10th</option> <option value="14">11th</option> <option value="15">12th</option> </select></td><td class="tar" colspan="3" style="line-height: 20px; padding-top: 5px; padding-bottom: 5px; text-align: right !important; background-color: rgb(255, 255, 255);"></td></tr><tr><td class="tar" style="line-height: 20px; padding-top: 5px; padding-bottom: 5px; text-align: right !important;"><label for="required">Board</label></td><td style="line-height: 20px; padding-top: 5px; padding-bottom: 5px;"><label>:</label></td><td style="line-height: 20px; padding-top: 5px; padding-bottom: 5px;"><input checked="checked" type="radio" name="af_board" id="af_board_1" value="1" style="margin-top: 0px;"> <label for="af_board_1">CBSE</label> <input type="radio" name="af_board" id="af_board_2" value="2" style="margin-top: 0px;"> <label for="af_board_2">RBSE</label> </td><td class="tar" colspan="3" style="line-height: 20px; padding-top: 5px; padding-bottom: 5px; text-align: right !important;"></td></tr><tr><td class="tar" style="line-height: 20px; padding-top: 5px; padding-bottom: 5px; text-align: right !important; background-color: rgb(255, 255, 255);"><label for="">XI/XII</label></td><td style="line-height: 20px; padding-top: 5px; padding-bottom: 5px; background-color: rgb(255, 255, 255);"><label>:</label></td><td colspan="4" style="line-height: 20px; padding-top: 5px; padding-bottom: 5px; background-color: rgb(255, 255, 255);"><input type="radio" name="af_specialization" id="af_specialization_1" value="1" style="margin-top: 0px;"> <label for="af_specialization_1">SCIENCE</label> <input type="radio" name="af_specialization" id="af_specialization_2" value="2" style="margin-top: 0px;"> <label for="af_specialization_2">ARTS</label> <input type="radio" name="af_specialization" id="af_specialization_3" value="3" style="margin-top: 0px;"> <label for="af_specialization_3">COMMERCE</label> </td></tr><tr><td class="tar" style="line-height: 20px; padding-top: 5px; padding-bottom: 5px; text-align: right !important;"><label for="">SCIENCE</label></td><td style="line-height: 20px; padding-top: 5px; padding-bottom: 5px;"><label>:</label></td><td colspan="4" style="line-height: 20px; padding-top: 5px; padding-bottom: 5px;"><input type="checkbox" name="subject_stream[1][1][]" id="subject_stream_1" value="1" style="margin-top: 0px;"> <label for="subject_stream_1">Physics</label> <input type="checkbox" name="subject_stream[1][1][]" id="subject_stream_2" value="2" style="margin-top: 0px;"> <label for="subject_stream_2">Chemistry</label> <input type="radio" name="subject_stream[1][1][]" id="subject_stream_3" value="3" style="margin-top: 0px;"> <label for="subject_stream_3">Biology</label> <input type="radio" name="subject_stream[1][1][]" id="subject_stream_4" value="4" style="margin-top: 0px;"> <label for="subject_stream_4">Maths</label> <input type="radio" name="subject_stream[1][1][]" id="subject_stream_5" value="5" style="margin-top: 0px;"> <label for="subject_stream_5">Computer</label> </td></tr><tr><td class="tar" style="line-height: 20px; padding-top: 5px; padding-bottom: 5px; text-align: right !important; background-color: rgb(255, 255, 255);"><label for="">ARTS</label></td><td style="line-height: 20px; padding-top: 5px; padding-bottom: 5px; background-color: rgb(255, 255, 255);"><label>:</label></td><td colspan="4" style="line-height: 20px; padding-top: 5px; padding-bottom: 5px; background-color: rgb(255, 255, 255);"><input type="radio" name="subject_stream[2][1][]" id="subject_stream_6" value="6" style="margin-top: 0px;"> <label for="subject_stream_6">Home Science</label> <input type="radio" name="subject_stream[2][1][]" id="subject_stream_7" value="7" style="margin-top: 0px;"> <label for="subject_stream_7">Maths</label> <input type="radio" name="subject_stream[2][1][]" id="subject_stream_8" value="8" style="margin-top: 0px;"> <label for="subject_stream_8">Hindi Litt.</label> <input type="radio" name="subject_stream[2][1][]" id="subject_stream_9" value="9" style="margin-top: 0px;"> <label for="subject_stream_9">English Litt.</label> <input type="radio" name="subject_stream[2][1][]" id="subject_stream_10" value="10" style="margin-top: 0px;"> <label for="subject_stream_10">Sanskrit</label> </td></tr><tr><td class="tar" style="line-height: 20px; padding-top: 5px; padding-bottom: 5px; text-align: right !important;"><label for=""></label></td><td style="line-height: 20px; padding-top: 5px; padding-bottom: 5px;"><label>:</label></td><td colspan="4" style="line-height: 20px; padding-top: 5px; padding-bottom: 5px;"><input type="radio" name="subject_stream[2][2][]" id="subject_stream_11" value="11" style="margin-top: 0px;"> <label for="subject_stream_11">Sociology</label> <input type="radio" name="subject_stream[2][2][]" id="subject_stream_12" value="12" style="margin-top: 0px;"> <label for="subject_stream_12">Political Science</label> <input type="radio" name="subject_stream[2][2][]" id="subject_stream_13" value="13" style="margin-top: 0px;"> <label for="subject_stream_13">Economics</label> <input type="radio" name="subject_stream[2][2][]" id="subject_stream_14" value="14" style="margin-top: 0px;"> <label for="subject_stream_14">History</label> <input type="radio" name="subject_stream[2][2][]" id="subject_stream_15" value="15" style="margin-top: 0px;"> <label for="subject_stream_15">Computer</label> </td></tr><tr><td class="tar" style="line-height: 20px; padding-top: 5px; padding-bottom: 5px; text-align: right !important; background-color: rgb(255, 255, 255);"><label for=""></label></td><td style="line-height: 20px; padding-top: 5px; padding-bottom: 5px; background-color: rgb(255, 255, 255);"><label>:</label></td><td colspan="4" style="line-height: 20px; padding-top: 5px; padding-bottom: 5px; background-color: rgb(255, 255, 255);"><input type="radio" name="subject_stream[2][3][]" id="subject_stream_16" value="16" style="margin-top: 0px;"> <label for="subject_stream_16">Geography</label> <input type="radio" name="subject_stream[2][3][]" id="subject_stream_17" value="17" style="margin-top: 0px;"> <label for="subject_stream_17">Music</label> <input type="radio" name="subject_stream[2][3][]" id="subject_stream_18" value="18" style="margin-top: 0px;"> <label for="subject_stream_18">Drawing & Painting</label> <input type="radio" name="subject_stream[2][3][]" id="subject_stream_19" value="19" style="margin-top: 0px;"> <label for="subject_stream_19">Public Administration </label> </td></tr><tr><td class="tar" style="line-height: 20px; padding-top: 5px; padding-bottom: 5px; text-align: right !important;"><label for="">COMMERCE</label></td><td style="line-height: 20px; padding-top: 5px; padding-bottom: 5px;"><label>:</label></td><td colspan="4" style="line-height: 20px; padding-top: 5px; padding-bottom: 5px;"><input type="checkbox" name="subject_stream[3][1][]" id="subject_stream_20" value="20" style="margin-top: 0px;"> <label for="subject_stream_20">Accountancy</label> <input type="checkbox" name="subject_stream[3][1][]" id="subject_stream_21" value="21" style="margin-top: 0px;"> <label for="subject_stream_21">Business Management</label> <input type="radio" name="subject_stream[3][1][]" id="subject_stream_22" value="22" style="margin-top: 0px;"> <label for="subject_stream_22">Economics</label> <input type="radio" name="subject_stream[3][1][]" id="subject_stream_23" value="23" style="margin-top: 0px;"> <label for="subject_stream_23">Maths </label> <input type="radio" name="subject_stream[3][1][]" id="subject_stream_24" value="24" style="margin-top: 0px;"> <label for="subject_stream_24">Computer</label> </td></tr><tr><td class="tar" style="line-height: 20px; padding-top: 5px; padding-bottom: 5px; text-align: right !important; background-color: rgb(255, 255, 255);"><label class="required" for="af_mobile_no" style="padding-right: 10px; background-image: url("../images/required-field.png"); background-position: 100% 0%; background-repeat: no-repeat;">Mobile No</label></td><td style="line-height: 20px; padding-top: 5px; padding-bottom: 5px; background-color: rgb(255, 255, 255);"><label>:</label></td><td style="line-height: 20px; padding-top: 5px; padding-bottom: 5px; background-color: rgb(255, 255, 255);"><input type="text" class="form-control validate[required]" id="af_mobile_no" name="af_mobile_no" value="" style="border-radius: 3px; color: rgb(85, 85, 85); font-size: 12px; height: auto; line-height: 18px; padding: 3px; transition-duration: 0.15s, 0.15s; transition-delay: 0s, 0s; vertical-align: middle; width: 214px; background-image: none;"></td><td class="tar" colspan="3" style="line-height: 20px; padding-top: 5px; padding-bottom: 5px; text-align: right !important; background-color: rgb(255, 255, 255);"></td></tr><tr><td style="line-height: 20px; padding-top: 5px; padding-bottom: 5px; height: 30px;"></td></tr><tr><td class="tar" style="line-height: 20px; padding-top: 5px; padding-bottom: 5px; text-align: right !important; background-color: rgb(255, 255, 255);"><label class="required" for="af_correspondence_address_line_1" style="padding-right: 10px; background-image: url("../images/required-field.png"); background-position: 100% 0%; background-repeat: no-repeat;">Correspondence Address Line 1</label></td><td style="line-height: 20px; padding-top: 5px; padding-bottom: 5px; background-color: rgb(255, 255, 255);"><label>:</label></td><td style="line-height: 20px; padding-top: 5px; padding-bottom: 5px; background-color: rgb(255, 255, 255);"><input type="text" class="form-control validate[required]" id="af_correspondence_address_line_1" name="af_correspondence_address_line_1" value="" style="border-radius: 3px; color: rgb(85, 85, 85); font-size: 12px; height: auto; line-height: 18px; padding: 3px; transition-duration: 0.15s, 0.15s; transition-delay: 0s, 0s; vertical-align: middle; width: 214px; background-image: none;"></td><td class="tar" colspan="3" style="line-height: 20px; padding-top: 5px; padding-bottom: 5px; text-align: right !important; background-color: rgb(255, 255, 255);"></td></tr><tr><td class="tar" style="line-height: 20px; padding-top: 5px; padding-bottom: 5px; text-align: right !important;"><label class="" for="af_correspondence_address_line_2">Line 2</label></td><td style="line-height: 20px; padding-top: 5px; padding-bottom: 5px;"><label>:</label></td><td style="line-height: 20px; padding-top: 5px; padding-bottom: 5px;"><input type="text" class="form-control" id="af_correspondence_address_line_2" name="af_correspondence_address_line_2" value="" style="border-radius: 3px; color: rgb(85, 85, 85); font-size: 12px; height: auto; line-height: 18px; padding: 3px; transition-duration: 0.15s, 0.15s; transition-delay: 0s, 0s; vertical-align: middle; width: 214px; background-image: none;"></td><td class="tar" colspan="3" style="line-height: 20px; padding-top: 5px; padding-bottom: 5px; text-align: right !important;"></td></tr><tr><td class="tar" style="line-height: 20px; padding-top: 5px; padding-bottom: 5px; text-align: right !important; background-color: rgb(255, 255, 255);"><label class="" for="af_correspondence_address_line_3">Line 3</label></td><td style="line-height: 20px; padding-top: 5px; padding-bottom: 5px; background-color: rgb(255, 255, 255);"><label>:</label></td><td style="line-height: 20px; padding-top: 5px; padding-bottom: 5px; background-color: rgb(255, 255, 255);"><input type="text" class="form-control" id="af_correspondence_address_line_3" name="af_correspondence_address_line_3" value="" style="border-radius: 3px; color: rgb(85, 85, 85); font-size: 12px; height: auto; line-height: 18px; padding: 3px; transition-duration: 0.15s, 0.15s; transition-delay: 0s, 0s; vertical-align: middle; width: 214px; background-image: none;"></td><td class="tar" colspan="3" style="line-height: 20px; padding-top: 5px; padding-bottom: 5px; text-align: right !important; background-color: rgb(255, 255, 255);"></td></tr><tr><td class="tar" style="line-height: 20px; padding-top: 5px; padding-bottom: 5px; text-align: right !important;"><label class="required" for="af_correspondence_state_id" style="padding-right: 10px; background-image: url("../images/required-field.png"); background-position: 100% 0%; background-repeat: no-repeat;">State</label></td><td style="line-height: 20px; padding-top: 5px; padding-bottom: 5px;"><label>:</label></td><td style="line-height: 20px; padding-top: 5px; padding-bottom: 5px;"><select class="form-control validate[required]" id="af_correspondence_state_id" name="af_correspondence_state_id" style="border-radius: 3px; color: rgb(85, 85, 85); font-size: 12px; height: auto; line-height: 18px; padding: 3px; transition-delay: 0s, 0s; vertical-align: middle; width: 214px; background-image: none;"> <option value="">--Select--</option> <option value="1">Andaman & Nicobar</option> <option value="2">Andhra Pradesh</option> <option value="3">Arunachal Pradesh</option> <option value="4">Assam</option> <option value="5">Bihar</option> <option value="6">Chandigarh</option> <option value="7">Chhattisgarh</option> <option value="8">Dadra and Nagar Haveli</option> <option value="9">Daman and Diu</option> <option value="10">Delhi</option> <option value="11">Goa</option> <option value="12">Gujarat</option> <option value="13">Haryana</option> <option value="14">Himachal Pradesh</option> <option value="15">Jammu & Kashmir</option> <option value="16">Jharkhand</option> <option value="17">Karnataka</option> <option value="18">Kerala</option> <option value="19">Lakshadweep</option> <option value="20">Madhya Pradesh</option> <option value="21">Maharashtra</option> <option value="22">Manipur</option> <option value="23">Meghalaya</option> <option value="24">Mizoram</option> <option value="25">Nagaland</option> <option value="26">Orissa</option> <option value="27">Pondicherry</option> <option value="28">Punjab</option> <option value="29" selected="selected">Rajasthan</option> <option value="30">Sikkim</option> <option value="31">Tamil Nadu</option> <option value="32">Tripura</option> <option value="34">Uttar Pradesh</option> <option value="33">Uttaranchal</option> <option value="35">West Bengal</option> </select></td><td class="tar" colspan="3" style="line-height: 20px; padding-top: 5px; padding-bottom: 5px; text-align: right !important;"></td></tr><tr><td class="tar" style="line-height: 20px; padding-top: 5px; padding-bottom: 5px; text-align: right !important; background-color: rgb(255, 255, 255);"><label class="required" for="af_correspondence_city_id" style="padding-right: 10px; background-image: url("../images/required-field.png"); background-position: 100% 0%; background-repeat: no-repeat;"><img src="http://www.shivjyoti.org/manager/images/loading3.gif" id="af_correspondence_city_id_loading" style="visibility: hidden;"> City</label></td><td style="line-height: 20px; padding-top: 5px; padding-bottom: 5px; background-color: rgb(255, 255, 255);"><label>:</label></td><td style="line-height: 20px; padding-top: 5px; padding-bottom: 5px; background-color: rgb(255, 255, 255);"><select class="form-control validate[required]" id="af_correspondence_city_id" name="af_correspondence_city_id" style="border-radius: 3px; color: rgb(85, 85, 85); font-size: 12px; height: auto; line-height: 18px; padding: 3px; transition-delay: 0s, 0s; vertical-align: middle; width: 214px; background-image: none;"> <option value="">--Select--</option> <option value="265">Ajmer</option> <option value="266">Alwar</option> <option value="465">Banswara</option> <option value="267">Bhilwara</option> <option value="268">Bikaner</option> <option value="431">Bundi</option> <option value="466">Chittorgarh</option> <option value="436">Hanumangarh</option> <option value="269">Jaipur</option> <option value="270">Jodhpur</option> <option value="271" selected="selected">Kota</option> <option value="449">Nagaur</option> <option value="411">Pali</option> <option value="412">Sikar</option> <option value="413">Sriganganagar</option> <option value="272">Udaipur</option> </select></td><td class="tar" colspan="3" style="line-height: 20px; padding-top: 5px; padding-bottom: 5px; text-align: right !important; background-color: rgb(255, 255, 255);"></td></tr><tr><td style="line-height: 20px; padding-top: 5px; padding-bottom: 5px; height: 30px;"></td></tr><tr><td class="tar" style="line-height: 20px; padding-top: 5px; padding-bottom: 5px; text-align: right !important; background-color: rgb(255, 255, 255);"><label class="required" for="af_permanent_address_line_1" style="padding-right: 10px; background-image: url("../images/required-field.png"); background-position: 100% 0%; background-repeat: no-repeat;">Permanent Address Line 1</label></td><td style="line-height: 20px; padding-top: 5px; padding-bottom: 5px; background-color: rgb(255, 255, 255);"><label>:</label></td><td style="line-height: 20px; padding-top: 5px; padding-bottom: 5px; background-color: rgb(255, 255, 255);"><input type="text" class="form-control validate[required]" id="af_permanent_address_line_1" name="af_permanent_address_line_1" value="" style="border-radius: 3px; color: rgb(85, 85, 85); font-size: 12px; height: auto; line-height: 18px; padding: 3px; transition-duration: 0.15s, 0.15s; transition-delay: 0s, 0s; vertical-align: middle; width: 214px; background-image: none;"></td><td class="tar" colspan="3" style="line-height: 20px; padding-top: 5px; padding-bottom: 5px; text-align: right !important; background-color: rgb(255, 255, 255);"></td></tr><tr><td class="tar" style="line-height: 20px; padding-top: 5px; padding-bottom: 5px; text-align: right !important;"><label class="" for="af_permanent_address_line_2">Line 2</label></td><td style="line-height: 20px; padding-top: 5px; padding-bottom: 5px;"><label>:</label></td><td style="line-height: 20px; padding-top: 5px; padding-bottom: 5px;"><input type="text" class="form-control" id="af_permanent_address_line_2" name="af_permanent_address_line_2" value="" style="border-radius: 3px; color: rgb(85, 85, 85); font-size: 12px; height: auto; line-height: 18px; padding: 3px; transition-duration: 0.15s, 0.15s; transition-delay: 0s, 0s; vertical-align: middle; width: 214px; background-image: none;"></td><td class="tar" colspan="3" style="line-height: 20px; padding-top: 5px; padding-bottom: 5px; text-align: right !important;"></td></tr><tr><td class="tar" style="line-height: 20px; padding-top: 5px; padding-bottom: 5px; text-align: right !important; background-color: rgb(255, 255, 255);"><label class="" for="af_permanent_address_line_3">Line 3</label></td><td style="line-height: 20px; padding-top: 5px; padding-bottom: 5px; background-color: rgb(255, 255, 255);"><label>:</label></td><td style="line-height: 20px; padding-top: 5px; padding-bottom: 5px; background-color: rgb(255, 255, 255);"><input type="text" class="form-control" id="af_permanent_address_line_3" name="af_permanent_address_line_3" value="" style="border-radius: 3px; color: rgb(85, 85, 85); font-size: 12px; height: auto; line-height: 18px; padding: 3px; transition-duration: 0.15s, 0.15s; transition-delay: 0s, 0s; vertical-align: middle; width: 214px; background-image: none;"></td><td class="tar" colspan="3" style="line-height: 20px; padding-top: 5px; padding-bottom: 5px; text-align: right !important; background-color: rgb(255, 255, 255);"></td></tr><tr><td class="tar" style="line-height: 20px; padding-top: 5px; padding-bottom: 5px; text-align: right !important;"><label class="required" for="af_permanent_state_id" style="padding-right: 10px; background-image: url("../images/required-field.png"); background-position: 100% 0%; background-repeat: no-repeat;">State</label></td><td style="line-height: 20px; padding-top: 5px; padding-bottom: 5px;"><label>:</label></td><td style="line-height: 20px; padding-top: 5px; padding-bottom: 5px;"><select class="form-control validate[required]" id="af_permanent_state_id" name="af_permanent_state_id" style="border-radius: 3px; color: rgb(85, 85, 85); font-size: 12px; height: auto; line-height: 18px; padding: 3px; transition-delay: 0s, 0s; vertical-align: middle; width: 214px; background-image: none;"> <option value="">--Select--</option> <option value="1">Andaman & Nicobar</option> <option value="2">Andhra Pradesh</option> <option value="3">Arunachal Pradesh</option> <option value="4">Assam</option> <option value="5">Bihar</option> <option value="6">Chandigarh</option> <option value="7">Chhattisgarh</option> <option value="8">Dadra and Nagar Haveli</option> <option value="9">Daman and Diu</option> <option value="10">Delhi</option> <option value="11">Goa</option> <option value="12">Gujarat</option> <option value="13">Haryana</option> <option value="14">Himachal Pradesh</option> <option value="15">Jammu & Kashmir</option> <option value="16">Jharkhand</option> <option value="17">Karnataka</option> <option value="18">Kerala</option> <option value="19">Lakshadweep</option> <option value="20">Madhya Pradesh</option> <option value="21">Maharashtra</option> <option value="22">Manipur</option> <option value="23">Meghalaya</option> <option value="24">Mizoram</option> <option value="25">Nagaland</option> <option value="26">Orissa</option> <option value="27">Pondicherry</option> <option value="28">Punjab</option> <option value="29" selected="selected">Rajasthan</option> <option value="30">Sikkim</option> <option value="31">Tamil Nadu</option> <option value="32">Tripura</option> <option value="34">Uttar Pradesh</option> <option value="33">Uttaranchal</option> <option value="35">West Bengal</option> </select></td><td class="tar" colspan="3" style="line-height: 20px; padding-top: 5px; padding-bottom: 5px; text-align: right !important;"></td></tr><tr><td class="tar" style="line-height: 20px; padding-top: 5px; padding-bottom: 5px; text-align: right !important; background-color: rgb(255, 255, 255);"><label class="required" for="af_permanent_city_id" style="padding-right: 10px; background-image: url("../images/required-field.png"); background-position: 100% 0%; background-repeat: no-repeat;"><img src="http://www.shivjyoti.org/manager/images/loading3.gif" id="af_permanent_city_id_loading" style="visibility: hidden;"> City</label></td><td style="line-height: 20px; padding-top: 5px; padding-bottom: 5px; background-color: rgb(255, 255, 255);"><label>:</label></td><td style="line-height: 20px; padding-top: 5px; padding-bottom: 5px; background-color: rgb(255, 255, 255);"><select class="form-control validate[required]" id="af_permanent_city_id" name="af_permanent_city_id" style="border-radius: 3px; color: rgb(85, 85, 85); font-size: 12px; height: auto; line-height: 18px; padding: 3px; transition-delay: 0s, 0s; vertical-align: middle; width: 214px; background-image: none;"> <option value="">--Select--</option> <option value="265">Ajmer</option> <option value="266">Alwar</option> <option value="465">Banswara</option> <option value="267">Bhilwara</option> <option value="268">Bikaner</option> <option value="431">Bundi</option> <option value="466">Chittorgarh</option> <option value="436">Hanumangarh</option> <option value="269">Jaipur</option> <option value="270">Jodhpur</option> <option value="271" selected="selected">Kota</option> <option value="449">Nagaur</option> <option value="411">Pali</option> <option value="412">Sikar</option> <option value="413">Sriganganagar</option> <option value="272">Udaipur</option> </select></td><td class="tar" colspan="3" style="line-height: 20px; padding-top: 5px; padding-bottom: 5px; text-align: right !important; background-color: rgb(255, 255, 255);"></td></tr></tbody></table></fieldset><fieldset class="formular" style="margin-bottom: 20px; border: 1px solid rgb(181, 184, 200); padding: 15px;"><legend class="formular" style="color: rgb(20, 102, 124); font-size: 15px; font-weight: bold; padding-right: 5px; padding-left: 5px; border-bottom-width: 0px !important; margin: 0px !important; width: auto !important;">Parent Information</legend><table class="table table-style" style="width: 822px; border-spacing: 1px; border-collapse: separate; background-color: rgb(247, 247, 247);"><tbody><tr><td class="tar" style="line-height: 20px; padding-top: 5px; padding-bottom: 5px; text-align: right !important; background-color: rgb(255, 255, 255);"><label class="required" for="af_father_name" style="padding-right: 10px; background-image: url("../images/required-field.png"); background-position: 100% 0%; background-repeat: no-repeat;">Father Name</label></td><td style="line-height: 20px; padding-top: 5px; padding-bottom: 5px; background-color: rgb(255, 255, 255);"><label>:</label></td><td style="line-height: 20px; padding-top: 5px; padding-bottom: 5px; background-color: rgb(255, 255, 255);"><input type="text" class="form-control validate[required]" id="af_father_name" name="af_father_name" value="" style="border-radius: 3px; color: rgb(85, 85, 85); font-size: 12px; height: auto; line-height: 18px; padding: 3px; transition-duration: 0.15s, 0.15s; transition-delay: 0s, 0s; vertical-align: middle; width: 213px; background-image: none;"></td><td class="tar" style="line-height: 20px; padding-top: 5px; padding-bottom: 5px; text-align: right !important; background-color: rgb(255, 255, 255);"><label class="required" for="af_father_contact_no" style="padding-right: 10px; background-image: url("../images/required-field.png"); background-position: 100% 0%; background-repeat: no-repeat;">Contact No</label></td><td style="line-height: 20px; padding-top: 5px; padding-bottom: 5px; background-color: rgb(255, 255, 255);"><label>:</label></td><td style="line-height: 20px; padding-top: 5px; padding-bottom: 5px; background-color: rgb(255, 255, 255);"><input type="text" class="form-control validate[required]" id="af_father_contact_no" name="af_father_contact_no" value="" style="border-radius: 3px; color: rgb(85, 85, 85); font-size: 12px; height: auto; line-height: 18px; padding: 3px; transition-duration: 0.15s, 0.15s; transition-delay: 0s, 0s; vertical-align: middle; width: 214px; background-image: none;"></td></tr><tr><td class="tar" style="line-height: 20px; padding-top: 5px; padding-bottom: 5px; text-align: right !important;"><label class="required" for="af_mother_name" style="padding-right: 10px; background-image: url("../images/required-field.png"); background-position: 100% 0%; background-repeat: no-repeat;">Mother Name</label></td><td style="line-height: 20px; padding-top: 5px; padding-bottom: 5px;"><label>:</label></td><td style="line-height: 20px; padding-top: 5px; padding-bottom: 5px;"><input type="text" class="form-control validate[required]" id="af_mother_name" name="af_mother_name" value="" style="border-radius: 3px; color: rgb(85, 85, 85); font-size: 12px; height: auto; line-height: 18px; padding: 3px; transition-duration: 0.15s, 0.15s; transition-delay: 0s, 0s; vertical-align: middle; width: 213px; background-image: none;"></td><td class="tar" style="line-height: 20px; padding-top: 5px; padding-bottom: 5px; text-align: right !important;"><label class="" for="af_mother_contact_no">Contact No</label></td><td style="line-height: 20px; padding-top: 5px; padding-bottom: 5px;"><label>:</label></td><td style="line-height: 20px; padding-top: 5px; padding-bottom: 5px;"><input type="text" class="form-control " id="af_mother_contact_no" name="af_mother_contact_no" value="" style="border-radius: 3px; color: rgb(85, 85, 85); font-size: 12px; height: auto; line-height: 18px; padding: 3px; transition-duration: 0.15s, 0.15s; transition-delay: 0s, 0s; vertical-align: middle; width: 214px; background-image: none;"></td></tr><tr><td class="tar" style="line-height: 20px; padding-top: 5px; padding-bottom: 5px; text-align: right !important; background-color: rgb(255, 255, 255);"><label class="required" for="af_father_occupation" style="padding-right: 10px; background-image: url("../images/required-field.png"); background-position: 100% 0%; background-repeat: no-repeat;">Father Occupation</label></td><td style="line-height: 20px; padding-top: 5px; padding-bottom: 5px; background-color: rgb(255, 255, 255);"><label>:</label></td><td style="line-height: 20px; padding-top: 5px; padding-bottom: 5px; background-color: rgb(255, 255, 255);"><input type="text" class="form-control validate[required]" id="af_father_occupation" name="af_father_occupation" value="" style="border-radius: 3px; color: rgb(85, 85, 85); font-size: 12px; height: auto; line-height: 18px; padding: 3px; transition-duration: 0.15s, 0.15s; transition-delay: 0s, 0s; vertical-align: middle; width: 213px; background-image: none;"></td><td colspan="3" style="line-height: 20px; padding-top: 5px; padding-bottom: 5px; background-color: rgb(255, 255, 255);"></td></tr></tbody></table></fieldset><fieldset class="formular" style="margin-bottom: 20px; border: 1px solid rgb(181, 184, 200); padding: 15px;"><legend class="formular" style="color: rgb(20, 102, 124); font-size: 15px; font-weight: bold; padding-right: 5px; padding-left: 5px; border-bottom-width: 0px !important; margin: 0px !important; width: auto !important;">Payment Information</legend><table class="table table-style" style="width: 822px; border-spacing: 1px; border-collapse: separate; background-color: rgb(247, 247, 247);"><tbody><tr><td class="tar" style="line-height: 20px; padding-top: 5px; padding-bottom: 5px; text-align: right !important; background-color: rgb(255, 255, 255);"><label class="required" for="af_payment_bank_name" style="padding-right: 10px; background-image: url("../images/required-field.png"); background-position: 100% 0%; background-repeat: no-repeat;">Bank Name</label></td><td style="line-height: 20px; padding-top: 5px; padding-bottom: 5px; background-color: rgb(255, 255, 255);"><label>:</label></td><td style="line-height: 20px; padding-top: 5px; padding-bottom: 5px; background-color: rgb(255, 255, 255);"><input type="text" class="form-control validate[required]" id="af_payment_bank_name" name="af_payment_bank_name" value="" style="border-radius: 3px; color: rgb(85, 85, 85); font-size: 12px; height: auto; line-height: 18px; padding: 3px; transition-duration: 0.15s, 0.15s; transition-delay: 0s, 0s; vertical-align: middle; width: 282px; background-image: none;"></td><td colspan="3" style="line-height: 20px; padding-top: 5px; padding-bottom: 5px; background-color: rgb(255, 255, 255);"></td></tr><tr><td class="tar" style="line-height: 20px; padding-top: 5px; padding-bottom: 5px; text-align: right !important;"><label class="required" for="af_payment_bank_state_name" style="padding-right: 10px; background-image: url("../images/required-field.png"); background-position: 100% 0%; background-repeat: no-repeat;">State Name</label></td><td style="line-height: 20px; padding-top: 5px; padding-bottom: 5px;"><label>:</label></td><td style="line-height: 20px; padding-top: 5px; padding-bottom: 5px;"><input type="text" class="form-control validate[required]" id="af_payment_bank_state_name" name="af_payment_bank_state_name" value="" style="border-radius: 3px; color: rgb(85, 85, 85); font-size: 12px; height: auto; line-height: 18px; padding: 3px; transition-duration: 0.15s, 0.15s; transition-delay: 0s, 0s; vertical-align: middle; width: 282px; background-image: none;"></td><td class="tar" style="line-height: 20px; padding-top: 5px; padding-bottom: 5px; text-align: right !important;"><label class="required" for="af_payment_bank_branch" style="padding-right: 10px; background-image: url("../images/required-field.png"); background-position: 100% 0%; background-repeat: no-repeat;">Branch Name</label></td><td style="line-height: 20px; padding-top: 5px; padding-bottom: 5px;"><label>:</label></td><td style="line-height: 20px; padding-top: 5px; padding-bottom: 5px;"><input type="text" class="form-control validate[required]" id="af_payment_bank_branch" name="af_payment_bank_branch" value="" style="border-radius: 3px; color: rgb(85, 85, 85); font-size: 12px; height: auto; line-height: 18px; padding: 3px; transition-duration: 0.15s, 0.15s; transition-delay: 0s, 0s; vertical-align: middle; width: 190px; background-image: none;"></td></tr><tr><td class="tar" style="line-height: 20px; padding-top: 5px; padding-bottom: 5px; text-align: right !important; background-color: rgb(255, 255, 255);"><label class="required" for="" style="padding-right: 10px; background-image: url("../images/required-field.png"); background-position: 100% 0%; background-repeat: no-repeat;">Payment Mode</label></td><td style="line-height: 20px; padding-top: 5px; padding-bottom: 5px; background-color: rgb(255, 255, 255);"><label>:</label></td><td style="line-height: 20px; padding-top: 5px; padding-bottom: 5px; background-color: rgb(255, 255, 255);"><input checked="checked" type="radio" name="af_payment_mode" id="af_payment_mode_1" value="1" style="margin-top: 0px;"> <label for="af_payment_mode_1">Net Banking</label> <input type="radio" name="af_payment_mode" id="af_payment_mode_2" value="2" style="margin-top: 0px;"> <label for="af_payment_mode_2">CASH</label> <input type="radio" name="af_payment_mode" id="af_payment_mode_3" value="3" style="margin-top: 0px;"> <label for="af_payment_mode_3">DD</label> </td><td colspan="3" style="line-height: 20px; padding-top: 5px; padding-bottom: 5px; background-color: rgb(255, 255, 255);"></td></tr><tr><td class="tar" style="line-height: 20px; padding-top: 5px; padding-bottom: 5px; text-align: right !important;"><label class="" for="af_payment_cheque_no">Cheque No</label></td><td style="line-height: 20px; padding-top: 5px; padding-bottom: 5px;"><label>:</label></td><td style="line-height: 20px; padding-top: 5px; padding-bottom: 5px;"><input type="text" class="form-control " id="af_payment_cheque_no" name="af_payment_cheque_no" value="" style="border-radius: 3px; color: rgb(85, 85, 85); font-size: 12px; height: auto; line-height: 18px; padding: 3px; transition-duration: 0.15s, 0.15s; transition-delay: 0s, 0s; vertical-align: middle; width: 282px; background-image: none;"></td><td class="tar" style="line-height: 20px; padding-top: 5px; padding-bottom: 5px; text-align: right !important;"><label class="" for="af_payment_dd_no">DD No</label></td><td style="line-height: 20px; padding-top: 5px; padding-bottom: 5px;"><label>:</label></td><td style="line-height: 20px; padding-top: 5px; padding-bottom: 5px;"><input type="text" class="form-control " id="af_payment_dd_no" name="af_payment_dd_no" value="" style="border-radius: 3px; color: rgb(85, 85, 85); font-size: 12px; height: auto; line-height: 18px; padding: 3px; transition-duration: 0.15s, 0.15s; transition-delay: 0s, 0s; vertical-align: middle; width: 190px; background-image: none;"></td></tr><tr><td class="tar" style="line-height: 20px; padding-top: 5px; padding-bottom: 5px; text-align: right !important; background-color: rgb(255, 255, 255);"><label class="required" for="af_payment_date" style="padding-right: 10px; background-image: url("../images/required-field.png"); background-position: 100% 0%; background-repeat: no-repeat;">Payment Date</label></td><td style="line-height: 20px; padding-top: 5px; padding-bottom: 5px; background-color: rgb(255, 255, 255);"><label>:</label></td><td style="line-height: 20px; padding-top: 5px; padding-bottom: 5px; background-color: rgb(255, 255, 255);"><input type="text" class="form-control validate[required] datepicker hasDatepicker" id="af_payment_date" name="af_payment_date" value="" style="border-radius: 3px; color: rgb(85, 85, 85); font-size: 12px; height: auto; line-height: 18px; padding: 3px; transition-duration: 0.15s, 0.15s; transition-delay: 0s, 0s; vertical-align: middle; width: 100px; background-image: none;"><img class="ui-datepicker-trigger" src="http://www.shivjyoti.org/manager/jquery.calendar/custom/images/calendar.png" alt="..." title="..."></td><td colspan="3" style="line-height: 20px; padding-top: 5px; padding-bottom: 5px; background-color: rgb(255, 255, 255);"></td></tr><tr><td class="tar" style="line-height: 20px; padding-top: 5px; padding-bottom: 5px; text-align: right !important;"><label class="required" for="af_payment_account_name" style="padding-right: 10px; background-image: url("../images/required-field.png"); background-position: 100% 0%; background-repeat: no-repeat;">Account Name</label></td><td style="line-height: 20px; padding-top: 5px; padding-bottom: 5px;"><label>:</label></td><td style="line-height: 20px; padding-top: 5px; padding-bottom: 5px;"><input type="text" class="form-control validate[required]" id="af_payment_account_name" name="af_payment_account_name" value="" style="border-radius: 3px; color: rgb(85, 85, 85); font-size: 12px; height: auto; line-height: 18px; padding: 3px; transition-duration: 0.15s, 0.15s; transition-delay: 0s, 0s; vertical-align: middle; width: 282px; background-image: none;"></td><td class="tar" style="line-height: 20px; padding-top: 5px; padding-bottom: 5px; text-align: right !important;"><label class="required" for="af_payment_account_no" style="padding-right: 10px; background-image: url("../images/required-field.png"); background-position: 100% 0%; background-repeat: no-repeat;">Account No</label></td><td style="line-height: 20px; padding-top: 5px; padding-bottom: 5px;"><label>:</label></td><td style="line-height: 20px; padding-top: 5px; padding-bottom: 5px;"><input type="text" class="form-control validate[required] " id="af_payment_account_no" name="af_payment_account_no" value="" style="border-radius: 3px; color: rgb(85, 85, 85); font-size: 12px; height: auto; line-height: 18px; padding: 3px; transition-duration: 0.15s, 0.15s; transition-delay: 0s, 0s; vertical-align: middle; width: 190px; background-image: none;"></td></tr><tr><td class="tar" style="line-height: 20px; padding-top: 5px; padding-bottom: 5px; text-align: right !important; background-color: rgb(255, 255, 255);"><label class="required" for="af_payment_total_amount" style="padding-right: 10px; background-image: url("../images/required-field.png"); background-position: 100% 0%; background-repeat: no-repeat;">Total Amount</label></td><td style="line-height: 20px; padding-top: 5px; padding-bottom: 5px; background-color: rgb(255, 255, 255);"><label>:</label></td><td style="line-height: 20px; padding-top: 5px; padding-bottom: 5px; background-color: rgb(255, 255, 255);"><input type="text" class="form-control validate[required] " id="af_payment_total_amount" name="af_payment_total_amount" value="" style="border-radius: 3px; color: rgb(85, 85, 85); font-size: 12px; height: auto; line-height: 18px; padding: 3px; transition-duration: 0.15s, 0.15s; transition-delay: 0s, 0s; vertical-align: middle; width: 282px; background-image: none;"></td><td class="tar" colspan="3" style="line-height: 20px; padding-top: 5px; padding-bottom: 5px; text-align: right !important; background-color: rgb(255, 255, 255);"></td></tr></tbody></table></fieldset><div><center><button class="btn btn-success" type="submit" name="Submit" style="padding: 10px;"><i class="fa fa-floppy-o"></i>Submit Admission Form</button></center></div></center></td></tr></tbody></table></center></td><td valign="top" bgcolor="#FFFFFF"> </td></tr><tr><td valign="top" bgcolor="#FFFFFF"> </td><td valign="top" bgcolor="#FFFFFF"><div class="lin_ks_1 mrb10 mrt10" style="margin-top: 10px; margin-bottom: 10px; border-bottom-color: rgb(153, 153, 153); border-bottom-style: dotted; border-bottom-width: 1px;"></div></td><td valign="top" bgcolor="#FFFFFF"> </td></tr></tbody></table><table align="center" width="985" background="http://www.shivjyoti.org/convent/footer-bg1.jpg" style="color: rgb(51, 51, 51); font-family: Arial, Helvetica, sans-serif; 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