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<!DOCTYPE html>
<html lang="en">
<!-- Mirrored from live.themewild.com/eduka/application-form.html by HTTrack Website Copier/3.x [XR&CO'2014], Fri, 06 Jun 2025 09:59:03 GMT -->
<head>
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<meta name="description" content="">
<meta name="keywords" content="">
<!-- title -->
<title>Eduka - School, College, University And Courses HTML5 Template</title>
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<link rel="icon" type="image/x-icon" href="assets/img/logo/favicon.png">
<!-- css -->
<link rel="stylesheet" href="assets/css/bootstrap.min.css">
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</head>
<body>
<!-- preloader -->
<div class="preloader">
<div class="loader-book">
<div class="loader-book-page"></div>
<div class="loader-book-page"></div>
<div class="loader-book-page"></div>
</div>
</div>
<!-- preloader end -->
<!-- header area -->
<header class="header">
<!-- header top -->
<div class="header-top">
<div class="container">
<div class="header-top-wrap">
<div class="header-top-left">
<div class="header-top-social">
<span>Follow Us: </span>
<a href="#"><i class="fab fa-facebook-f"></i></a>
<a href="#"><i class="fab fa-instagram"></i></a>
<a href="#"><i class="fab fa-youtube"></i></a>
<a href="#"><i class="fab fa-whatsapp"></i></a>
</div>
</div>
<div class="header-top-right">
<div class="header-top-contact">
<ul>
<li>
<a href="#"><i class="far fa-location-dot"></i> 25/B Milford Road, New York</a>
</li>
<li>
<a href="https://live.themewild.com/cdn-cgi/l/email-protection#f79e999198b7928f969a879b92d994989a"><i class="far fa-envelopes"></i> <span class="__cf_email__" data-cfemail="761f18101936130e171b061a135815191b">[email protected]</span></a>
</li>
<li>
<a href="tel:+21236547898"><i class="far fa-phone-volume"></i> +2 123 654 7898</a>
</li>
</ul>
</div>
</div>
</div>
</div>
</div>
<div class="main-navigation">
<nav class="navbar navbar-expand-lg">
<div class="container position-relative">
<a class="navbar-brand" href="index.html">
<img src="assets/img/logo/logo.png" alt="logo">
</a>
<div class="mobile-menu-right">
<div class="search-btn">
<button type="button" class="nav-right-link search-box-outer"><i
class="far fa-search"></i></button>
</div>
<button class="navbar-toggler" type="button" data-bs-toggle="collapse"
data-bs-target="#main_nav" aria-expanded="false" aria-label="Toggle navigation">
<span class="navbar-toggler-mobile-icon"><i class="far fa-bars"></i></span>
</button>
</div>
<div class="collapse navbar-collapse" id="main_nav">
<ul class="navbar-nav">
<li class="nav-item dropdown">
<a class="nav-link dropdown-toggle active" href="#" data-bs-toggle="dropdown">Home</a>
<ul class="dropdown-menu fade-down">
<li><a class="dropdown-item" href="index.html">Home Page 01</a></li>
<li><a class="dropdown-item" href="index-2.html">Home Page 02</a></li>
<li><a class="dropdown-item" href="index-3.html">Home Page 03</a></li>
</ul>
</li>
<li class="nav-item dropdown">
<a class="nav-link dropdown-toggle" href="#" data-bs-toggle="dropdown">Courses</a>
<ul class="dropdown-menu fade-down">
<li><a class="dropdown-item" href="course.html">Courses One</a></li>
<li><a class="dropdown-item" href="course-2.html">Courses Two</a></li>
<li><a class="dropdown-item" href="course-single.html">Course Single One</a></li>
<li><a class="dropdown-item" href="course-single-2.html">Course Single Two</a></li>
</ul>
</li>
<li class="nav-item mega-menu dropdown">
<a class="nav-link dropdown-toggle" href="#" data-bs-toggle="dropdown">Academics</a>
<div class="dropdown-menu fade-down">
<div class="mega-content">
<div class="container-fluid">
<div class="row">
<div class="col-12 col-sm-4 col-md-3">
<h5>About Us</h5>
<div class="menu-about">
<a href="#" class="menu-about-logo"><img
src="assets/img/logo/logo-light.png" alt=""></a>
<p>We are many variations of passages available but the majority
have suffered alteration in some form by injected humour
words injected humour believable.</p>
</div>
</div>
<div class="col-12 col-sm-4 col-md-3">
<h5>Undergraduate</h5>
<ul class="mega-menu-item">
<li><a class="dropdown-item" href="academic-single.html">Art And
Design</a></li>
<li><a class="dropdown-item" href="academic-single.html">Acting
And Drama</a></li>
<li><a class="dropdown-item"
href="academic-single.html">Accounting And Finance</a>
</li>
<li><a class="dropdown-item" href="academic-single.html">Biology
And Conservation</a></li>
<li><a class="dropdown-item" href="academic-single.html">Science
And Engineering</a></li>
</ul>
</div>
<div class="col-12 col-sm-4 col-md-3">
<h5>Graduate Program</h5>
<ul class="mega-menu-item">
<li><a class="dropdown-item"
href="academic-single.html">Software Systems</a></li>
<li><a class="dropdown-item" href="academic-single.html">Human
Resource</a></li>
<li><a class="dropdown-item" href="academic-single.html">Health
Administration</a></li>
<li><a class="dropdown-item"
href="academic-single.html">Biochemistry</a></li>
<li><a class="dropdown-item"
href="academic-single.html">Computer Science</a></li>
</ul>
</div>
<div class="col-12 col-sm-12 col-md-3">
<h5>Resources</h5>
<ul class="mega-menu-item">
<li><a class="dropdown-item" href="academic.html">Academics
Department</a></li>
<li><a class="dropdown-item"
href="academic-single.html">Academic Department
Single</a></li>
<li><a class="dropdown-item" href="faculty.html">Our Faculty</a>
</li>
<li><a class="dropdown-item" href="faculty-single.html">Faculty
Single</a></li>
<li><a class="dropdown-item" href="contact.html">Contact With
Us</a></li>
</ul>
</div>
</div>
</div>
</div>
</div>
</li>
<li class="nav-item dropdown">
<a class="nav-link dropdown-toggle" href="#" data-bs-toggle="dropdown">Pages</a>
<ul class="dropdown-menu fade-down">
<li><a class="dropdown-item" href="about.html">About Us</a></li>
<li class="dropdown-submenu">
<a class="dropdown-item dropdown-toggle" href="#">Events</a>
<ul class="dropdown-menu">
<li><a class="dropdown-item" href="event.html">Events</a></li>
<li><a class="dropdown-item" href="event-single.html">Event Single</a></li>
</ul>
</li>
<li class="dropdown-submenu">
<a class="dropdown-item dropdown-toggle" href="#">Portfolio</a>
<ul class="dropdown-menu">
<li><a class="dropdown-item" href="portfolio.html">Portfolio</a></li>
<li><a class="dropdown-item" href="portfolio-single.html">Portfolio
Single</a></li>
</ul>
</li>
<li class="dropdown-submenu">
<a class="dropdown-item dropdown-toggle" href="#">Teachers</a>
<ul class="dropdown-menu">
<li><a class="dropdown-item" href="teacher.html">Teachers One</a></li>
<li><a class="dropdown-item" href="teacher-2.html">Teachers Two</a></li>
<li><a class="dropdown-item" href="teacher-single.html">Teachers Single</a>
</li>
</ul>
</li>
<li><a class="dropdown-item" href="gallery.html">Gallery</a></li>
<li class="dropdown-submenu">
<a class="dropdown-item dropdown-toggle" href="#">Authentication</a>
<ul class="dropdown-menu">
<li><a class="dropdown-item" href="login.html">Login</a></li>
<li><a class="dropdown-item" href="register.html">Register</a></li>
<li><a class="dropdown-item" href="forgot-password.html">Forgot Password</a>
</li>
</ul>
</li>
<li><a class="dropdown-item" href="pricing.html">Pricing Plan</a></li>
<li><a class="dropdown-item" href="faq.html">Faq</a></li>
<li><a class="dropdown-item" href="testimonial.html">Testimonials</a></li>
<li><a class="dropdown-item" href="404.html">404 Error</a></li>
<li><a class="dropdown-item" href="coming-soon.html">Coming Soon</a></li>
<li><a class="dropdown-item" href="terms.html">Terms Of Service</a></li>
<li><a class="dropdown-item" href="privacy.html">Privacy Policy</a></li>
</ul>
</li>
<li class="nav-item dropdown">
<a class="nav-link dropdown-toggle" href="#" data-bs-toggle="dropdown">Admissions</a>
<ul class="dropdown-menu fade-down">
<li><a class="dropdown-item" href="how-to-apply.html">How To Apply</a></li>
<li><a class="dropdown-item" href="application-form.html">Application Form</a></li>
<li class="dropdown-submenu">
<a class="dropdown-item dropdown-toggle" href="#">Our Campus</a>
<ul class="dropdown-menu">
<li><a class="dropdown-item" href="campus-tour.html">Campus Tour</a></li>
<li><a class="dropdown-item" href="campus-life.html">Campus Life</a></li>
<li><a class="dropdown-item" href="notice-board.html">Notice Board</a></li>
<li><a class="dropdown-item" href="student-activities.html">Student
Activities</a></li>
</ul>
</li>
<li class="dropdown-submenu">
<a class="dropdown-item dropdown-toggle" href="#">Our Facilities</a>
<ul class="dropdown-menu">
<li><a class="dropdown-item" href="facility.html">Facilities</a></li>
<li><a class="dropdown-item" href="facility-single.html">Facility Single</a></li>
</ul>
</li>
<li class="dropdown-submenu">
<a class="dropdown-item dropdown-toggle" href="#">Our Research</a>
<ul class="dropdown-menu">
<li><a class="dropdown-item" href="research.html">Research</a></li>
<li><a class="dropdown-item" href="research-single.html">Research Single</a>
</li>
</ul>
</li>
<li class="dropdown-submenu">
<a class="dropdown-item dropdown-toggle" href="#">Our Clubs</a>
<ul class="dropdown-menu">
<li><a class="dropdown-item" href="club.html">Our Clubs</a></li>
<li><a class="dropdown-item" href="club-single.html">Club Single</a></li>
</ul>
</li>
<li><a class="dropdown-item" href="tuition-fee.html">Tuition Fees</a></li>
<li><a class="dropdown-item" href="alumni.html">Alumni</a></li>
<li><a class="dropdown-item" href="scholarship.html">Scholarships</a></li>
<li><a class="dropdown-item" href="our-fund.html">Our Fund</a></li>
<li><a class="dropdown-item" href="athletics.html">Athletics</a></li>
<li><a class="dropdown-item" href="health-care.html">Health Care</a></li>
</ul>
</li>
<li class="nav-item dropdown">
<a class="nav-link dropdown-toggle" href="#" data-bs-toggle="dropdown">Blog</a>
<ul class="dropdown-menu fade-down">
<li><a class="dropdown-item" href="blog.html">Blog</a></li>
<li><a class="dropdown-item" href="blog-single.html">Blog Single</a></li>
</ul>
</li>
<li class="nav-item"><a class="nav-link" href="contact.html">Contact</a></li>
</ul>
<div class="nav-right">
<div class="search-btn">
<button type="button" class="nav-right-link search-box-outer"><i
class="far fa-search"></i></button>
</div>
<div class="nav-right-btn mt-2">
<a href="application-form.html" class="theme-btn"><span
class="fal fa-pencil"></span>Apply Now</a>
</div>
</div>
</div>
</div>
</nav>
</div>
</header>
<!-- header area end -->
<!-- popup search -->
<div class="search-popup">
<button class="close-search"><span class="far fa-times"></span></button>
<form action="#">
<div class="form-group">
<input type="search" name="search-field" placeholder="Search Here..." required>
<button type="submit"><i class="far fa-search"></i></button>
</div>
</form>
</div>
<!-- popup search end -->
<main class="main">
<!-- breadcrumb -->
<div class="site-breadcrumb" style="background: url(assets/img/breadcrumb/01.jpg)">
<div class="container">
<h2 class="breadcrumb-title">Application Form</h2>
<ul class="breadcrumb-menu">
<li><a href="index.html">Home</a></li>
<li class="active">Application Form</li>
</ul>
</div>
</div>
<!-- breadcrumb end -->
<!-- application -->
<div class="application py-120">
<div class="container">
<div class="application-form">
<h3>Application Form</h3>
<form action="#">
<div class="row">
<h5 class="mb-3">Basic Information</h5>
<div class="col-lg-6">
<div class="form-group">
<label>First Name</label>
<input type="text" class="form-control" name="firstname" placeholder="Your First Name">
</div>
</div>
<div class="col-lg-6">
<div class="form-group">
<label>Last Name</label>
<input type="text" class="form-control" name="lastname" placeholder="Your Last Name">
</div>
</div>
<div class="col-lg-6">
<div class="form-group">
<label>Program Type</label>
<select class="form-select" name="program">
<option value="">Choose Program Type</option>
<option value="1">Program Type 01</option>
<option value="2">Program Type 02</option>
<option value="3">Program Type 03</option>
</select>
</div>
</div>
<div class="col-lg-6">
<div class="form-group">
<label>Degree Level</label>
<select class="form-select" name="degree">
<option value="">Choose Degree Level</option>
<option value="1">Degree Level 01</option>
<option value="2">Degree Level 02</option>
<option value="3">Degree Level 03</option>
</select>
</div>
</div>
<div class="col-lg-6">
<div class="form-group">
<label>Student Photo</label>
<input type="file" class="form-control" name="photo" aria-describedby="photohelp">
<div id="photohelp" class="form-text">Your Photo Must be in Passport (PP) Size. Max Upload Size 1MB.</div>
</div>
</div>
<div class="col-lg-6">
<div class="form-group">
<label>Upload Passport or Birth Document</label>
<input type="file" class="form-control" name="document" aria-describedby="dochelp">
<div id="dochelp" class="form-text">Upload File Must Be Zip File. Max Upload Size 1MB.</div>
</div>
</div>
<h5 class="mt-4 mb-3">Personal Information</h5>
<div class="col-lg-6">
<div class="form-group">
<label>Father's Name</label>
<input type="text" class="form-control" name="fathername" placeholder="Your Father's Name">
</div>
</div>
<div class="col-lg-6">
<div class="form-group">
<label>Mother's Name</label>
<input type="text" class="form-control" name="mothername" placeholder="Your Mother's Name">
</div>
</div>
<div class="col-lg-6">
<div class="form-group">
<label>Contact Number</label>
<input type="text" class="form-control" name="number" placeholder="Your Contact Number">
</div>
</div>
<div class="col-lg-6">
<div class="form-group">
<label>Email Address</label>
<input type="email" class="form-control" name="email" placeholder="Your Email Address">
</div>
</div>
<div class="col-lg-12">
<div class="form-group">
<label>Present Address</label>
<input type="text" class="form-control" name="address" placeholder="Your Present Address">
</div>
</div>
<div class="col-lg-6">
<div class="form-group">
<label>Date Of Birth</label>
<input type="date" class="form-control" name="dob">
</div>
</div>
<div class="col-lg-6">
<div class="form-group">
<label>National ID Or Passport ID</label>
<input type="text" class="form-control" name="nid" placeholder="Your ID Number">
</div>
</div>
<div class="col-lg-6">
<div class="form-group">
<label>Gender</label>
<select class="form-select" name="gender">
<option value="">Choose Gender</option>
<option value="1">Male</option>
<option value="2">Female</option>
<option value="3">Others</option>
</select>
</div>
</div>
<div class="col-lg-6">
<div class="form-group">
<label>Student Type</label>
<select class="form-select" name="studenttype">
<option value="">Choose Student Type</option>
<option value="1">Student Type 01</option>
<option value="2">Student Type 02</option>
<option value="3">Student Type 03</option>
</select>
</div>
</div>
<h5 class="mt-4 mb-3">Academic Information</h5>
<div class="col-lg-6">
<div class="form-group">
<label>School</label>
<input type="text" class="form-control" name="school" placeholder="Your School">
</div>
</div>
<div class="col-lg-6">
<div class="form-group">
<label>Year Of Completion</label>
<input type="text" class="form-control" name="yoc" placeholder="Completion Year">
</div>
</div>
<div class="col-lg-6">
<div class="form-group">
<label>Highest Qualification</label>
<input type="text" class="form-control" name="qualification" placeholder="Your Qualification">
</div>
</div>
<div class="col-lg-6">
<div class="form-group">
<label>Current Status</label>
<select class="form-select" name="status">
<option value="">Choose Current Status</option>
<option value="1">Current Status 01</option>
<option value="2">Current Status 02</option>
<option value="3">Current Status 03</option>
</select>
</div>
</div>
<div class="col-lg-6">
<div class="form-group">
<label>Study Area</label>
<select class="form-select" name="studyarea">
<option value="">Choose Study Area</option>
<option value="1">Study Area 01</option>
<option value="2">Study Area 02</option>
<option value="3">Study Area 03</option>
</select>
</div>
</div>
<div class="col-lg-6">
<div class="form-group">
<label>Academic Degree Level</label>
<select class="form-select" name="academicdegree">
<option value="">Choose Degree Level</option>
<option value="1">Academic Degree Level 01</option>
<option value="2">Academic Degree Level 02</option>
<option value="3">Academic Degree Level 03</option>
</select>
</div>
</div>
<div class="col-lg-12">
<div class="form-check">
<input class="form-check-input" type="checkbox" id="agree" name="agree" value="1">
<label class="form-check-label" for="agree">
By Submitting This Form You Agree To The <a href="#">Terms & Conditions</a> And <a href="#">Privacy Policy</a>.
</label>
</div>
</div>
<div class="col-lg-12">
<button type="submit" class="theme-btn">Submit Application<i class="fas fa-arrow-right-long"></i></button>
</div>
</div>
</form>
</div>
</div>
</div>
<!-- application end-->
</main>
<!-- footer area -->
<footer class="footer-area">
<div class="footer-shape">
<img src="assets/img/shape/03.png" alt="">
</div>
<div class="footer-widget">
<div class="container">
<div class="row footer-widget-wrapper pt-100 pb-70">
<div class="col-md-6 col-lg-4">
<div class="footer-widget-box about-us">
<a href="#" class="footer-logo">
<img src="assets/img/logo/logo-light.png" alt="">
</a>
<p class="mb-3">
We are many variations of passages available but the majority have suffered alteration
in some form by injected humour words believable.
</p>
<ul class="footer-contact">
<li><a href="tel:+21236547898"><i class="far fa-phone"></i>+2 123 654 7898</a></li>
<li><i class="far fa-map-marker-alt"></i>25/B Milford Road, New York</li>
<li><a href="https://live.themewild.com/cdn-cgi/l/email-protection#9ef7f0f8f1defbe6fff3eef2fbb0fdf1f3"><i
class="far fa-envelope"></i><span class="__cf_email__" data-cfemail="f0999e969fb09588919d809c95de939f9d">[email protected]</span></a></li>
</ul>
</div>
</div>
<div class="col-md-6 col-lg-2">
<div class="footer-widget-box list">
<h4 class="footer-widget-title">Quick Links</h4>
<ul class="footer-list">
<li><a href="#"><i class="fas fa-caret-right"></i> About Us</a></li>
<li><a href="#"><i class="fas fa-caret-right"></i> FAQ's</a></li>
<li><a href="#"><i class="fas fa-caret-right"></i> Testimonials</a></li>
<li><a href="#"><i class="fas fa-caret-right"></i> Terms Of Service</a></li>
<li><a href="#"><i class="fas fa-caret-right"></i> Privacy policy</a></li>
<li><a href="#"><i class="fas fa-caret-right"></i> Update News</a></li>
</ul>
</div>
</div>
<div class="col-md-6 col-lg-3">
<div class="footer-widget-box list">
<h4 class="footer-widget-title">Our Campus</h4>
<ul class="footer-list">
<li><a href="#"><i class="fas fa-caret-right"></i> Campus Safety</a></li>
<li><a href="#"><i class="fas fa-caret-right"></i> Student Activities</a></li>
<li><a href="#"><i class="fas fa-caret-right"></i> Academic Department</a></li>
<li><a href="#"><i class="fas fa-caret-right"></i> Planning & Administration</a></li>
<li><a href="#"><i class="fas fa-caret-right"></i> Office Of The Chancellor</a></li>
<li><a href="#"><i class="fas fa-caret-right"></i> Facility Services</a></li>
</ul>
</div>
</div>
<div class="col-md-6 col-lg-3">
<div class="footer-widget-box list">
<h4 class="footer-widget-title">Newsletter</h4>
<div class="footer-newsletter">
<p>Subscribe Our Newsletter To Get Latest Update And News</p>
<div class="subscribe-form">
<form action="#">
<input type="email" class="form-control" placeholder="Your Email">
<button class="theme-btn" type="submit">
Subscribe Now <i class="far fa-paper-plane"></i>
</button>
</form>
</div>
</div>
</div>
</div>
</div>
</div>
</div>
<div class="copyright">
<div class="container">
<div class="copyright-wrapper">
<div class="row">
<div class="col-md-6 align-self-center">
<p class="copyright-text">
© Copyright <span id="date"></span> <a href="#"> Eduka </a> All Rights Reserved.
</p>
</div>
<div class="col-md-6 align-self-center">
<ul class="footer-social">
<li><a href="#"><i class="fab fa-facebook-f"></i></a></li>
<li><a href="#"><i class="fab fa-whatsapp"></i></a></li>
<li><a href="#"><i class="fab fa-linkedin-in"></i></a></li>
<li><a href="#"><i class="fab fa-youtube"></i></a></li>
</ul>
</div>
</div>
</div>
</div>
</div>
</footer>
<!-- footer area end -->
<!-- scroll-top -->
<a href="#" id="scroll-top"><i class="far fa-arrow-up-from-arc"></i></a>
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