Formulir Penapisan Risiko COVID-19 UB 18 Maret 2020

JavaScript isn't enabled in your browser, so this file can't be opened. Enable and reload.

Formulir Penapisan Risiko COVID-19 UB 18 Maret 2020

Kepada Yth Mahasiswa

Berikut kami sampaikan formulir penapisan gejala CoVID-19. Mohon diiisi dengan sebenar benarnya.

Untuk keterangan lebih lanjut, bisa menghubungi Satgas COVID-19 UB (+62 811-3631-611)

ttd

Satgas COVID-19 UB

Sign in to Google to save your progress. Learn more

* Indicates required question

NIM *

Your answer

Nama *

Your answer

no HP

Your answer

Fakultas

Your answer

Program Studi *

Your answer

Next

Clear form

Never submit passwords through Google Forms.

This form was created inside of Universitas Brawijaya. Report Abuse