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<title>IICE Academy Siliguri Admission in NIOS Board for Drop Out Student</title>
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** Apply Online **
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<section class="login-wrapper register">
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<div class="login-logo"> <a href="index.html"><img src="images/login-logo.png" class="img-responsive" alt=""></a> </div>
<div class="head-block">
<h1>Apply Now</h1></br>
<h6 style="color:#C60">Online Admission</h6>
</div>
<div class="cnt-block">
<form action="form.php" method="post" class="form-outer" enctype="multipart/form-data">
<div class="row">
<h2 style="color:#063"> <u>Full Name (English) :</u></h2>
<div class="col-sm-6">
<input name="First Name" type="text" placeholder="Manoj Singh....">
</div>
<div class="col-sm-6">
<h2 style="color:#063"><u>Father's/Husband Name:</u></h2>
<input name="Last Name" type="text" placeholder="Raj Singh .....">
</div>
</div>
<div class="row">
<div class="col-sm-6">
<h2 style="color:#063"><u>Email id :</u></h2>
<input name="Street" type="text" placeholder="email....">
</div>
<div class="col-sm-6">
<h2 style="color:#063"><u>Mother's Name :</u></h2>
<input name="Apartment" type="text" placeholder="Gayanti Devi....">
</div>
</div>
<div class="row">
<div class="col-sm-6">
<h2 style="color:#C00"><u>Course Applied For :</u></h2>
<select class="custom_select">
<option value="State">Courses</option>
<option value="Tamilnadu">Secondary</option>
<option value="Karnataka">Sr.Secondary</option>
<option value="Tamilnadu">UG</option>
<option value="Tamilnadu">PG</option>
<option value="Karnataka">B.ED</option>
<option value="Tamilnadu">D.EL.ED</option>
<option value="Tamilnadu">M.ED</option>
<option value="Karnataka">D.Pharma</option>
<option value="Tamilnadu">B.Pharma</option>
<option value="Tamilnadu">B. Sc Nursing</option>
<option value="Karnataka">GNM</option>
</select>
</div>
<div class="col-sm-6">
<h2 style="color:#C00"><u>Medium Of Study :</u></h2>
<select class="custom_select">
<option value="State">Hindi</option>
<option value="Tamilnadu">English</option>
<option value="Karnataka">Urdu</option>
</select>
</div>
</div>
<div class="row">
<div class="col-sm-6">
<h2 style="color:#C00"><u>Category :</u></h2>
<select class="custom_select">
<option value="Country">GN</option>
<option value="UK">SC</option>
<option value="USA">ST</option>
<option value="UAE">EBC</option>
<option value="USA">BC</option>
<option value="UAE">EX Army</option>
</select>
</div>
<div class="col-sm-6 clearfix">
<h2 style="color:#063"><u>Nationality :</u></h6>
<input name="Email" type="text" placeholder="iNDIAN....">
</div>
</div>
<div class="row">
<div class="col-sm-6">
<h2 style="color:#063"><u>Mobile No. :</u></h2>
<input name="Email" type="text" placeholder="Mobile No.....">
</div>
<div class="col-sm-6">
<h2 style="color:#063"><u>Previous Education
Qualification: :</u></h2>
<input name="Email" type="text" placeholder="Previous Education
Qualification.....">
</div>
</div>
<div class="row">
<div class="col-sm-6">
<h2 style="color:#C00"><u>Occupation :</u></h2>
<select class="custom_select">
<option value="How did you hear about us?">Student</option>
<option value="How did you hear about us?">Employed</option>
<option value="How did you hear about us?">Self Employed</option>
<option value="How did you hear about us?">Ex Serviceman</option>
</select>
</div>
<div class="col-sm-6">
<h2 style="color:#C00"><u> DATE OF BIRTH : :</u></h2>
<div class="date">
<input type='text' class="datepicker" placeholder="DATE OF BIRTH " />
<span class="icon-calander-icon"></span> </div>
</div>
</div>
<div class="row">
<div class="col-sm-6 clearfix">
<div class="col-left">
<h2>Gender</h2>
<ul class="select-opt clearfix">
<li>
<input id="f-option" name="selector" type="radio">
<label for="f-option">Male</label>
<div class="check"></div>
</li>
<li>
<input id="s-option" name="selector" type="radio">
<label for="s-option">Female</label>
<div class="check">
<div class="inside"></div>
</div>
</li>
</ul>
</div>
<div class="col-left">
<h2>Marital Status:</h2>
<ul class="select-opt clearfix">
<li>
<input id="y-option" name="selector" type="radio">
<label for="y-option">Married</label>
<div class="check"></div>
</li>
<li>
<input id="n-option" name="selector" type="radio">
<label for="n-option">Un Married</label>
<div class="check">
<div class="inside"></div>
</div>
</li>
</ul>
</div>
</div>
<div class="col-sm-6">
<div class="col-left">
<h2>Disability:</h2>
<ul class="select-opt clearfix">
<li>
<input id="z-option" name="selector" type="radio">
<label for="z-option">Yes</label>
<div class="check"></div>
</li>
<li>
<input id="o-option" name="selector" type="radio">
<label for="o-option">No</label>
<div class="check">
<div class="inside"></div>
</div>
</li>
</ul>
</div>
<div class="col-sm-6">
<div class="col-left">
<h2>Kind Of Disability:</h2>
<ul class="select-opt clearfix">
<input name="Email" type="text" placeholder="Kind Of Disability....">
</ul>
</div>
</div>
</div>
<div class="button-outer">
<button class="btn">Submit & Pay Now<span class="icon-more-icon"></span></button>
</div>
</form>
</div>
</div>
</div>
</section>
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