COVID Vaccination Survey

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Post Graduate Government College,Sector-46, Chandigarh

Your e-mail address *

Full Name *

Class *

BA -I(Sem II)

BA -II(Sem IV)

BA-III (Sem VI)

BCom-I (Sem II)

BCom-II (Sem IV)

BCom-III(Sem VI)

BCA-I ( Sem II)

BCA- II (Sem IV)

BCA- III (Sem VI)

BBA-I (Sem II)

BBA-II (Sem IV)

BBA-III(Sem VI)

MCOM-I

MCOM-II

College Roll No. *

Mobile Number *

Gender *

Female

Male

Prefer not to say

Other:

Date of Birth *

YYYY

Have you ever tested positive for SARS-CoV-2 in the past? *

Yes

If yes,mention the date and month.

YYYY

Have you got vaccinated ? *

Yes

On which date was the first dose administered?

YYYY

Vaccine administered

Covishield

Covaxin

Sputnik V

Clear selection

On which date is the second dose of vaccine due?

YYYY

If not vaccinated, mention the reason *

Submit

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