Nigerian Youth Compact on COVID-19
STUDENT MEMBERSHIP FORM
NYCCOVID-19
Full Name (Surname first) *
Contact Address *
Phone *
Email *
Date of Birth *
MM
/
DD
/
YYYY
State of origin *
State of Residence *
Name of Tertiary Institution *
Department /Course of Study *
Level *
Do you have a voter card❓ *
Have you voted before *
Do you have an idea of what COVID-19 is all about❓ *
Hav you been in any Leadership position before❓ *
Would you like participate in our Student Enlightenment Program on COVID-19❓ *
How did you obtain information about the program? *
Required
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