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Kharagpur College Covid SOS
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Full Name
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Email ID
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Relationship with College
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Teacher
Student
Parents
Other
Student Name (if relationship with college is parent)
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Profession
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Teacher
Student
Doctor
Chemist
Psychologist
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Department
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Semester
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SEM 1
SEM 2
SEM 3
SEM 4
SEM 5
SEM 6
Mobile No
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No. of Family Member
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0
1
2
3
4
5
6
7
8
9
10
No. of Family members having health concern
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0
1
2
3
4
5
6
7
8
9
10
Type of Health Concern
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NA
Covid
Covid not Life Threatening
Kind of Support Needed at Present
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Would you like to be a Volunteer ?
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Not this time
Any Other Remarks
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Address
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State
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