Madan Mohan Malaviya University of Technology, Gorakhpur
Message From Hon'ble Chancellor
MADAN MOHAN MALAVIYA UNIVERSITY OF TECHNOLOGY, GORAKHPUR
Madan Mohan Malaviya
University of Technology,
Gorakhpur (u.p.) India
COVID VACCINATION DRIVE
Email ID/Roll No.
Note : Student must enter Univ Roll No. and Faculty/Staff must enter Email Id/Mobile No.
(Please fill the following details of the Person whom you have assisted for vaccination.)
Name of Person
Name of Village/Town/City
Age of Person
Person is Family Relative?
(Please Attach Vaccination certificate/Photograph at tht time of inoculation)
Name of P.H.C./Hospital
Remarks or Suggestion