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
...
Your
Email ID/Roll No.
*
Note : Student must enter Univ Roll No. and Faculty/Staff must enter Email Id/Mobile No.
Your Name
*
(Please fill the following details of the Person whom you have assisted for vaccination.)
Name of Person
Name of Village/Town/City
Select Type
*
Select---
Self
Other
Age of Person
*
Person is Family Relative?
YES
NO
File/Image Attachment
*
(Please Attach Vaccination certificate/Photograph at tht time of inoculation)
Name of P.H.C./Hospital
Remarks or Suggestion