Barishal Polytechnic Institute, Barishal.
Students Vaccine Information
Email *
Students Name *
Students Active mobile number *
Board Roll. *
Board Registration Number
Department *
Semester *
NID Number
 Birth Registration Number
Date of Birth *
MM
/
DD
/
YYYY
Registration for COVID-19 Vaccination completed in "Surokkha website/ App *
Date of Vaccine registration
MM
/
DD
/
YYYY
First dose Vaccine taken *
First dose Vaccine date
MM
/
DD
/
YYYY
Second dose Vaccine taken *
Second dose Vaccine date
MM
/
DD
/
YYYY
A copy of your responses will be emailed to the address you provided.
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