Chapra Bangaljhi Mahavidyalaya Vaccination Data Collection Form
Email *
Name of Student *
Subject /Course *
Semester *
Gender *
Date of Birth *
MM
/
DD
/
YYYY
Age *
Mobile No. *
ID Number (AADHAR/EPIC) *
Dose Required 1st Dose/2nd Dose *
Type of Vaccine (Covaxin/Covishield) *
A copy of your responses will be emailed to the address you provided.
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