Covid-19 Vaccination Form
Full Name
Student ID
Email address
Gender
Man
Woman
Major
Address
Do you already vaccinated??
ALREADY
NOT YET
Fill your vaccine information
Kind of Vaccine
Sinovac
AstraZeneca
Novavax
Sinopharm
Moderna
Pfizer
What dose?
Certificate ID
Vaccination Date
Reasons for not getting vaccinated
Submit