<html>
<head>
<title>T3 - Student Registration Form</title>
<style>
legend {
font-size: x-large;
}
td {
font-size: larger;
}
input {
font-size: medium;
}
</style>
</head>
<body align="center">
<h1>Task 3 - Student Registration Form</h1>
<form>
<table align="center" cellpadding="10">
<tr>
<td>
<fieldset>
<legend>Personal Information</legend>
<table>
<tr>
<td>First Name:</td>
<td><input type="text" name="firstname" placeholder="First Name" required></td>
</tr>
<tr>
<td>Last Name:</td>
<td><input type="text" name="lastname" placeholder="Last Name" required></td>
</tr>
<tr>
<td>Father's Name:</td>
<td><input type="text" name="fname" placeholder="Father's Name" required></td>
</tr>
<tr>
<td>Mother's Name:</td>
<td><input type="text" name="mname" placeholder="Mother's Name" required></td>
</tr>
<tr>
<td>Date of Birth:</td>
<td><input type="date" name="dob" required></td>
</tr>
<tr>
<td>Email:</td>
<td><input type="email" name="email" placeholder="Email" required></td>
</tr>
<tr>
<td>Phone Number:</td>
<td><input type="tel" name="phone" placeholder="Phone Number" required></td>
</tr>
<tr>
<td>Father's Phone No.:</td>
<td><input type="tel" name="phone" placeholder="Father's Phone Number" required></td>
</tr>
<tr>
<td>Gender:</td>
<td>
<input type="radio" name="gender" value="male"> Male
<input type="radio" name="gender" value="female"> Female
<input type="radio" name="gender" value="other"> Other
</td>
</tr>
<tr>
<td>Physical Disability :</td>
<td><input type="radio" name="disability" value="Yes"> Yes
<input type="radio" name="disability" value="No"> No
</td>
</tr>
<tr>
<td>Income (>2.5Lac) :</td>
<td><input type="radio" name="income" value="Yes"> Yes
<input type="radio" name="income" value="No"> No
</td>
</tr>
<tr>
<td>Btech Mode :</td>
<td><input type="radio" name="bmode" value="regular"> Regular
<input type="radio" name="bmode" value="distance"> Distance
</td>
</tr>
<tr>
<td>Aadhaar Number :</td>
<td><input type="number" name="Aadhaar" placeholder="Aadhaar Number" required></td>
</tr>
<tr>
<td>Category :</td>
<td>
<select>
<option value="">Select</option>
<option value="sc">SC</option>
<option value="st">ST</option>
<option value="general">General</option>
<option value="obc">OBC</option>
<option value="ews">EWS</option>
</select>
</td>
</tr>
</table>
</fieldset>
</td>
</tr>
<tr>
<td>
<fieldset>
<legend>Educational Background</legend>
<table>
<tr>
<td>10th Grade School:</td>
<td><input type="text" name="ssc_school" placeholder="10th Grade School" required></td>
</tr>
<tr>
<td>10th Grade Year of Passing:</td>
<td><input type="number" name="ssc_year" placeholder="10th Grade Year of Passing"
required></td>
</tr>
<tr>
<td>10th Grade Marks (%):</td>
<td><input type="number" name="ssc_marks" placeholder="10th Grade Marks (%)" required>
</td>
</tr>
<tr>
<td>12th Grade School:</td>
<td><input type="text" name="hsc_school" placeholder="12th Grade School" required></td>
</tr>
<tr>
<td>12th Grade Year of Passing:</td>
<td><input type="number" name="hsc_year" placeholder="12th Grade Year of Passing"
required></td>
</tr>
<tr>
<td>12th Grade Marks (%):</td>
<td><input type="number" name="hsc_marks" placeholder="12th Grade Marks (%)" required>
</td>
</tr>
<tr>
<td>Diploma Institution:</td>
<td><input type="text" name="diploma_school" placeholder="Diploma Institution"></td>
</tr>
<tr>
<td>Diploma Year of Passing:</td>
<td><input type="number" name="diploma_year" placeholder="Diploma Year of Passing"></td>
</tr>
<tr>
<td>Diploma Marks (%):</td>
<td><input type="number" name="diploma_marks" placeholder="Diploma Marks (%)"></td>
</tr>
</table>
</fieldset>
</td>
</tr>
<tr>
<td>
<fieldset>
<legend>Course Preference</legend>
<table>
<tr>
<td>B.Tech Branch Preference:</td>
<td>
<select name="btech_branch" required>
<option value="">Select Branch</option>
<option value="cse">Computer Science Engineering</option>
<option value="ece">Electronics and Communication Engineering</option>
<option value="eee">Electrical and Electronics Engineering</option>
<option value="me">Mechanical Engineering</option>
<option value="ce">Civil Engineering</option>
<option value="it">Information Technology</option>
</select>
</td>
</tr>
<tr>
<td>Mode of Study:</td>
<td>
<input type="radio" name="mode_of_study" value="regular" required> Regular
<input type="radio" name="mode_of_study" value="distance" required> Distance
</td>
</tr>
<tr>
<td>Preferred Class Timings:</td>
<td>
<input type="radio" name="class_timings" value="morning" required> Morning
<input type="radio" name="class_timings" value="afternoon" required> Afternoon
<input type="radio" name="class_timings" value="evening" required> Evening
</td>
</tr>
</table>
</fieldset>
</td>
</tr>
<tr>
<td>
<fieldset>
<legend>Additional Information</legend>
<table>
<tr>
<td>Address:</td>
<td><textarea name="address" rows="4" cols="50" placeholder="Address"
required></textarea></td>
</tr>
<tr>
<td>City:</td>
<td><input type="text" name="city" placeholder="City" required></td>
</tr>
<tr>
<td>State:</td>
<td><input type="text" name="state" placeholder="State" required></td>
</tr>
<tr>
<td>Zip Code:</td>
<td><input type="text" name="zipcode" placeholder="Zip Code" required></td>
</tr>
<tr>
<td>How did you hear about us?</td>
<td>
<select name="reference" required>
<option value="" disabled selected>Select</option>
<option value="online">Online Advertisement</option>
<option value="friend">Friend/Family</option>
<option value="school">School/College</option>
<option value="event">Educational Event</option>
</select>
</td>
</tr>
<tr>
<td>Additional Comments:</td>
<td><textarea name="comments" rows="4" cols="50"
placeholder="Additional Comments"></textarea></td>
</tr>
</table>
</fieldset>
</td>
</tr>
<tr>
<td align="center"><input type="submit" value="Submit Application"></td>
</tr>
</table>
</form>
</body>
</html>