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COVID Vaccination Survey
Post Graduate Government College,Sector-46, Chandigarh
* Indicates required question
Your e-mail address
*
Your answer
Full Name
*
Your answer
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.
*
Your answer
Mobile Number
*
Your answer
Gender
*
Female
Male
Prefer not to say
Other:
Date of Birth
*
MM
/
DD
/
YYYY
Have you ever tested positive for SARS-CoV-2 in the past?
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Yes
No
If yes,mention the date and month.
MM
/
DD
/
YYYY
Have you got vaccinated ?
*
Yes
No
On which date was the first dose administered?
MM
/
DD
/
YYYY
Vaccine administered
Covishield
Covaxin
Sputnik V
Clear selection
On which date is the second dose of vaccine due?
MM
/
DD
/
YYYY
If not vaccinated, mention the reason
*
Your answer
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