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nadelinn - rinduu

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Directory :  /var/www/html/shardahospital.org/shardalms/lms/lms/student-panel/views/phd/
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current_dir [ Writeable ] document_root [ Writeable ]

 
Current File : /var/www/html/shardahospital.org/shardalms/lms/lms/student-panel/views/phd/step1.html
<form id="step1form" autocomplete="off">
    <div class="row">
        <div class="col-md-12">
            <div class="heading">BASIC DETAILS</div>
        </div>
        <div class="col-md-4 col-sm-6">
            <div class="form-group">
                <label>Applicant's Full Name</label>
                <input type="text" class="form-control" name="name" ng-model="cr.data.name" placeholder="Enter Your Name">
            </div>
        </div>
        <div class="col-md-4 col-sm-6">
            <div class="form-group">
                <label>Applicant's Mobile</label>
                <input type="text" class="form-control" readonly name="mob" ng-model="cr.data.mob" placeholder="Enter Your Mobile No.">
            </div>
        </div>
        <div class="col-md-4 col-sm-6">
            <div class="form-group">
                <label>Applicant's Email ID </label>
                <input type="text" class="form-control" readonly name="email" ng-model="cr.data.email" placeholder="Enter Your Email ID">
            </div>
        </div>
        <div class="col-md-4 col-sm-6">
            <div class="form-group">
                <label>Academic Career</label>
                <input type="hidden" name="ac_id" value="{{cr.data.ac_id}}" />
                <select class="form-control arrow" ng-model="cr.data.ac_id" ng-change="cr.data.program_id=''" disabled>
                    <option value="">Select Academic Career</option>
                    <option value="{{r.id}}" ng-repeat="r in cr.dds.acs">{{r.title}}</option>
                </select>
            </div>
        </div>
        <div class="col-md-4 col-sm-6">
            <div class="form-group">
                <label>Programme</label>
                <select class="form-control arrow" name="program_id" ng-model="cr.data.program_id" ng-change="cr.data.plan_id=''">
                    <option value="">Select Programme</option>
                    <option value="{{r.id}}" ng-repeat="r in cr.dds.programs" ng-if="r.ac_id==cr.data.ac_id">{{r.title}}</option>
                </select>
            </div>
        </div>
        <div class="col-md-4 col-sm-6">
            <div class="form-group">
                <label>Plan/Specialization</label>
                <select class="form-control arrow" name="plan_id" ng-model="cr.data.plan_id">
                    <option value="">Select Specialization</option>
                    <option value="{{r.id}}" ng-repeat="r in cr.dds.plans" ng-if="r.program_id==cr.data.program_id">{{r.title}}</option>
                </select>
            </div>
        </div>
        <div class="clearfix"></div>
        
        <div class="col-md-4 col-sm-6">
            <div class="form-group">
                <label>State</label>
                <select class="form-control arrow" name="state_id" ng-model="cr.data.state_id" ng-change="cr.data.city_id=''">
                    <option value="">Select State</option>
                    <option value="{{r.id}}" ng-repeat="r in cr.dds.states">{{r.title}}</option>
                </select>
            </div>
        </div>
        <div class="col-md-4 col-sm-6">
            <div class="form-group">
                <label>City</label>
                <select class="form-control arrow" name="city_id" ng-model="cr.data.city_id">
                    <option value="">Select City</option>
                    <option value="{{r.id}}" ng-repeat="r in cr.dds.cities" ng-if="r.state_id==cr.data.state_id">{{r.title}}</option>
                    <option value="-1">Other</option>
                </select>
            </div>
        </div>
        <div class="col-md-4 col-sm-6">
            <div class="form-group">
                <label>Other City</label>
                <input type="text" class="form-control" name="city" ng-value="cr.data.city_id!='-1'?'':cr.data.city" ng-disabled="cr.data.city_id!='-1'" placeholder="">
            </div>
        </div>
        <div class="clearfix"></div>

        <div class="col-md-12">
            <div class="heading_mrg"></div>
            <div class="heading">
                ADDITIONAL DETAILS
            </div>
        </div>
        <div class="col-md-3">
            <div class="form-group">
                <label>Applicant's DOB</label>
                <input type="text" class="form-control cal hasCal" name="dob" ng-model="cr.data.dob" placeholder="Date of Birth">
            </div>
        </div>
        <div class="col-md-3">
            <div class="form-group">
                <label>Applicant's Gender</label>
                <select class="form-control arrow" name="gender" ng-model="cr.data.gender">
                    <option value="">Select Gender</option>
                    <option value="Male">Male</option>
                    <option value="Female">Female</option>
                    <option value="Other">Other</option>
                </select>
            </div>
        </div>
        <div class="col-md-3">
            <div class="form-group">
                <label>Applicant's Category</label>
                <select class="form-control arrow" name="cat_id" ng-model="cr.data.cat_id">
                    <option value="">Select Category</option>
                    <option value="{{r.id}}" ng-repeat="r in cr.dds.applicant_cats">{{r.title}}</option>
                </select>
            </div>
        </div>
        <div class="col-md-3">
            <div class="form-group">
                <label>Applicant's Religion</label>
                <select class="form-control arrow" name="religion_id" ng-model="cr.data.religion_id">
                    <option value="">Select Religion</option>
                    <option value="{{r.id}}" ng-repeat="r in cr.dds.religions">{{r.title}}</option>
                </select>
            </div>
        </div>
        <div class="clearfix"></div>

        <div class="col-md-6">
            <div class="form-group">
                <label>Permanent Address</label>
                <input type="text" class="form-control" name="address" ng-model="cr.data.address" placeholder="Permanent Address">
            </div>
        </div>
        <div class="col-md-3">
            <div class="form-group">
                <label>Pincode</label>
                <input type="text" class="form-control" name="pincode" ng-model="cr.data.pincode" maxlength="6" placeholder="Pincode">
            </div>
        </div>
        <div class="col-md-3">
            <div class="form-group">
                <label>Place Of Birth</label>
                <input type="text" class="form-control" name="pob" ng-model="cr.data.pob" placeholder="Place Of Birth">
            </div>
        </div>
        <div class="clearfix"></div>
        <div class="col-md-3">
            <div class="form-group">
                <label>Domicile State</label>
                <select class="form-control arrow" name="domicile_state_id" ng-model="cr.data.domicile_state_id">
                    <option value="">Select State</option>
                    <option value="{{r.id}}" ng-repeat="r in cr.dds.states">{{r.title}}</option>
                </select>
            </div>
        </div>
        <div class="col-md-3">
            <div class="form-group">
                <label>Physically Challenged</label>
                <select class="form-control arrow" name="physically_challenged" ng-model="cr.data.physically_challenged">
                    <option value="N">No</option>
                    <option value="Y">Yes</option>
                </select>
            </div>
        </div>
        <div class="col-md-3">
            <div class="form-group">
                <label>Nationality</label>
                <select class="form-control arrow" name="nationality" ng-model="cr.data.nationality">
                    <option value="">Select Nationality</option>
                    <option>Indian</option>
                    <option>Other Than India</option>
                </select>
            </div>
        </div>
        <div class="col-md-3">
            <div class="form-group">
                <label>Mother's Name</label>
                <input type="text" class="form-control" name="mother_name" ng-model="cr.data.mother_name" placeholder="Mother's Name">
            </div>
        </div>
        <div class="col-md-3">
            <div class="form-group">
                <label>Mother's Qualification</label>
                <input type="text" class="form-control" name="mother_qualification" ng-model="cr.data.mother_qualification" placeholder="Mother's Qualification">
            </div>
        </div>
        <div class="col-md-3">
            <div class="form-group">
                <label>Mother's Occupation</label>
                <input type="text" class="form-control" name="mother_occupation" ng-model="cr.data.mother_occupation" placeholder="Mother's Occupation">
            </div>
        </div>
        <div class="col-md-3">
            <div class="form-group">
                <label>Father's Name</label>
                <input type="text" class="form-control" name="father_name" ng-model="cr.data.father_name" placeholder="Father's Name">
            </div>
        </div>
        <div class="col-md-3">
            <div class="form-group">
                <label>Father's Qualification</label>
                <input type="text" class="form-control" name="father_qualification" ng-model="cr.data.father_qualification" placeholder="Father's Qualification">
            </div>
        </div>
        <div class="col-md-3">
            <div class="form-group">
                <label>Father's Occupation</label>
                <input type="text" class="form-control" name="father_occupation" ng-model="cr.data.father_occupation" placeholder="Father's Occupation">
            </div>
        </div>

        <div class="col-md-3">
            <div class="form-group">
                <label>Household Income (Per Annum)</label>
                <select class="form-control arrow" name="house_income" ng-model="cr.data.house_income">
                    <option value="">Select</option>
                    <option>Less than 1,00,000</option>
                    <option>1,00,001-3,00,000</option>
                    <option>3,00,001-5,00,000</option>
                    <option>5,00,001-8,00,000</option>
                    <option>Above 8,00,000</option>
                </select>
            </div>
        </div>
        <div class="col-md-3">
            <div class="form-group">
                <label>ID Proof</label>
                <select class="form-control arrow" name="id_proof" ng-model="cr.data.id_proof">
                    <option value="">Select</option>
                    <option>Aadhaar Number</option>
                    <option>Pan Card Number</option>
                    <option>Passport Number</option>
                    <option>Other ID</option>
                </select>
            </div>
        </div>
        <div class="col-md-3">
            <div class="form-group">
                <label>ID Proof Details</label>
                <input type="text" class="form-control" name="id_proof_dtl" ng-model="cr.data.id_proof_dtl" placeholder="ID Proof Details">
            </div>
        </div>
        <div class="col-md-3">
            <div class="form-group">
                <label>ABC ID</label>
                <input type="text" class="form-control" name="abc_id" ng-model="cr.data.abc_id" placeholder="ABC ID">
            </div>
        </div>
        <div class="col-md-3">
            <div class="form-group">
                <label>Landline No</label>
                <input type="text" class="form-control" name="landline" ng-model="cr.data.landline" placeholder="Landline No">
            </div>
        </div>
        <div class="col-md-3">
            <div class="form-group">
                <label>Alternate Mobile No</label>
                <input type="text" class="form-control" name="parent_mob" ng-model="cr.data.parent_mob" placeholder="Alternate Mobile No">
            </div>
        </div>
        <div class="col-md-3">
            <div class="form-group">
                <label>Alternate Email Id</label>
                <input type="text" class="form-control" name="parent_email" ng-model="cr.data.parent_email" placeholder="Alternate Email Id">
            </div>
        </div>
        <div class="col-md-3">
            <div class="form-group">
                <label>Source of Information</label>
                <select class="form-control arrow" name="source_of_info" ng-model="cr.data.source_of_info">
                    <option value="">Select</option>
                    <option>Online/Internet</option>
                    <option>Newspaper</option>
                    <option>TV</option>
                    <option>Radio</option>
                    <option>Hoarding</option>
                    <option>Walk-in</option>
                    <option>Education Fair</option>
                    <option>University Students</option>
                    <option>Friends/Relatives</option>
                    <option>Consultant</option>
                    <option>Others</option>
                </select>
            </div>
        </div>
        <div class="clearfix"></div>
    </div>
    <p class="text-center">
        <button class="button green" ng-click="cr.saveStep1()">Save & Next <i class="fa fa-angle-right" aria-hidden="true"></i></button>
    </p>
</form>

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