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COVID-19 Vaccine -Student/Employee Survey
Survey as per Government/ VTU Circular
* Indicates required question
Email
*
Your email
NAME
*
Your answer
CATEGORY
*
Choose
UG -STUDENT
PG - STUDENT
FACULTY
NON TEACHING
OTHERS
STUDENT USN / STAFF ID
*
Your answer
CONTACT NUMBER
*
Your answer
SEMESTER (FOR STUDENT ONLY)
Choose
1
2
3
4
5
6
7
8
DEPARTMENT/COURSE
*
Choose
Mechanical Engineering
Civil Engineering
Computer Science & Engineering
Information Science & Engineering
Industrial production and Engineering
Electrical and Electronics6
Electronics and Communications
Physics
Chemistry
Mathematics
Master of Computer Application
Information Technology
Computer Network Engineering
Industrial Automation and Robotics
Structural Engineering
Nano Technology
Machine Design
Computer Application to Industrial Drives
Power Systems
Production Engineering System Technology
Hydraulics
Office / Others
Civil - Evening
1
VACCINE NAME
*
Choose
COVISHIELD
COVAXIN
OTHER
NOT YET VACCINATED
FIRST DOSE VACCINATED DATE
MM
/
DD
/
YYYY
SECOND DOSE VACCINATED DATE
MM
/
DD
/
YYYY
NOT VACCINATED - REASON
Your answer
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