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Covid'19 Vaccination Data
Vivekananda College
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* Indicates required question
Name of the student
*
Your answer
Student Id / Roll:
*
Your answer
Semester
*
1st Semester
2nd Semester
3rd Semester
4th Semester
5th Semester
6th Semester
Contact no
*
Your answer
ID Proof (Aadhar / Epic No)
*
Your answer
Gender
*
Male
Female
Prefer not to say
Other:
Required
Date of birth
*
MM
/
DD
/
YYYY
Age
*
Your answer
Doses taken
*
1st Dose
2nd Dose
Not Taken
Required
1st dose Taken of covid vaccine date
MM
/
DD
/
YYYY
2nd dose Taken of covid vaccine date
MM
/
DD
/
YYYY
Vaccine taken
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Covaxin
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