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Barishal Polytechnic Institute, Barishal.
Students Vaccine Information
* Indicates required question
Email
*
Your email
Students Name
*
Your answer
Students Active mobile number
*
Your answer
Board Roll.
*
Your answer
Board Registration Number
Your answer
Department
*
Choose
Civil
Electrical
Mechanical
Power
Electromedical
Computer
Tourism & Hospitality
Electronics
Semester
*
Choose
2nd
4th
6th
8th
NID Number
Your answer
Birth Registration Number
Your answer
Date of Birth
*
MM
/
DD
/
YYYY
Registration for COVID-19 Vaccination completed in "Surokkha website/ App
*
Yes
No
Date of Vaccine registration
MM
/
DD
/
YYYY
First dose Vaccine taken
*
Yes
No
First dose Vaccine date
MM
/
DD
/
YYYY
Second dose Vaccine taken
*
Yes
No
Second dose Vaccine date
MM
/
DD
/
YYYY
A copy of your responses will be emailed to the address you provided.
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