Covid-19 Vaccine for Students - Distance and Continuing Education Unit(DCEU), University of Ruhuna.

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A COVID19 vaccination program (SINOPHARM) will be conducted on Wednesday 13th October 2021 at Wellamadama Premises of University of Ruhuna and Faculty of Agriculture, Mapalana , Kamburupitiya for all University Students living in the Southern Province.

The objective of this survey is to count the number of students to be vaccinated at the Covid-19 vaccination center which will be established in the University of Ruhuna.

1. This survey is only applicable for any DCEU Registered student.
2. Always provide honest and accurate information.
3. We will use this information only for this task.

We would really appreciate your kind response to this survey to make this task a success.

Your name with initials *

Your national identity card (NIC) number *

Age *

Select the program you are studying under DCEU *

Your registration number *

Pls type your registration number with full format

Address of your current residence *

Grama Niladari Davison (GND) of your current residence *

District of your current residence *

Nearest MOH office to your current residence *

Your email address *

Your contact number (mobile number preferred) *

I here by declare that I didn't get single dose of any Covid-19 vaccine *

Confirm

Required

Do you have any allergies to vaccines or drugs? *

Yes

Preferred Vaccination Centre ? *

University of Ruhuna, Wellamadama , Matara

Faculty of Agriculture, University of Ruhuna, Kamburupitiya

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