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INFORMATION ABOUT COVID-19 VACCINE
DINABANDHU MAHAVIDYALAYA ,BONGAON
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Email
*
Your email
NAME OF THE STUDENT
*
Your answer
SUBJECT/Course
*
BA GEN
BSC GEN
BCOM GEN
BA HONS
BSC HONS
BCOM HONS
HONS SUBJECT
Your answer
YEAR/SEMESTER
*
1st sem
2nd sem
3rd sem
4th sem
5th sem
GENDER
*
MALE
FEMALE
DATE OF BIRTH
*
MM
/
DD
/
YYYY
AGE
*
Your answer
MOB.NO
*
Your answer
ID NUMBER(AADHAR/EPIC ETC)
*
Your answer
DOES REQUIRED VACCINE
*
1ST DOSE
2ND DOSE
Two dose completed
IF 2ND DOSE REQUIRED : DATE OF 1ST DOSE
MM
/
DD
/
YYYY
IF 2ND DOSE REQUIRED: TYPE OF VACCINE
COVAXIN
COVISHIELD
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