Kabinazrul College Vaccination Data Collection Form

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Kabinazrul College Vaccination Data Collection Form

* Indicates required question

Email *

Your email

Name of Student *

Your answer

Subject /Course *

Choose

Bengali Hons

English Hons

Geography Hons

History Hons

Philosophy Hons

Pol Sc Hons

BA General

Bsc General

BCom Hons

BCom General

Semester *

Choose

1

2

3

4

5

6

Gender *

Choose

Male

Female

Date of Birth *

MM

/

DD

/

YYYY

Age *

Your answer

Mobile No. *

Your answer

ID Number (AADHAR/EPIC) *

Your answer

Dose Required 1st Dose/2nd Dose *

Choose

1st Dose

2nd Dose

Both Dose Completed

Type of Vaccine (Covaxin/Covishield)

Choose

Covaxin

Covishield

A copy of your responses will be emailed to the address you provided.

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