Survey: Vaccination Status

Name: (Last Name, First Name)

What is your vaccination status as of today?

Fully Vaccinated (Completed 1st and 2nd dose)

Partially Vaccinated (Completed 1st dose only)

Not yet vaccinated (Has vaccination schedule already)

Not yet vaccinated (No vaccination schedule yet)

Will not get vaccination

For those who are vaccinated already: Do you have a vaccination card?

Yes, I have a vaccination card

No, I don't have a vaccination card yet

For those who are not vaccinated yet and has no vaccination schedule yet, Would you like the school to help for a vaccination schedule?

Yes, i would like to ask for help for a vaccination schedule

No, we will look for our own vaccination schedule

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