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Students Vaccine Update Information
Hajee Mohammad Danesh Science and Technology University, Dinajpur-5200.
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* Indicates required question
1.
Student’s Name:
*
Your answer
2.
Student ID No:
*
Your answer
3.
Name of Degree:
*
Your answer
4.
Level:
*
Your answer
5.
Semester:
*
Your answer
6.
Name of Department (Optional)
Your answer
7.
Name of Faculty
*
Your answer
8.
Name of Hall
*
Your answer
9.
Residential Status of Hall:
*
A. Residential
B. Non-Residential
9.
Residential Status of Hall:
*
A. Residential
B. Non-Residential
10.
If non-residential then please write your address (Mess or home)
Your answer
11.
NID Number:
Your answer
12.
If you do not have NID number, then what is the status of your application for getting NID number (Applied/Not Applied Yet)
Your answer
13.
Contact Mobile Number:
*
Your answer
14.
Email address:
*
Your answer
15.
Have you taken COVID-19 Vaccine
*
Yes
No
16.
Have you taken 1st dose only or Both dosages
Your answer
17.
Date of first COVID-19 Vaccine
MM
/
DD
/
YYYY
18.
Date of 2nd dose of COVID-19 Vaccine
MM
/
DD
/
YYYY
19.
If not taken the COVID-19 Vaccine, then have you completed registration for the vaccine?
Yes
No
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20. If no, then what is your plan for COVID-19 Vaccination?
Your answer
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