Private School Registration

Fill accurate school details including name, full address, and district/block.
Provide valid contact information of the Principal and the Nodal Teacher for coordination.
Enter the number of girl students aged between 9–14 years eligible for HPV vaccination.
Mention tentative dates and time when your school can organize the vaccination session
After selecting your district, contact details of the District Immunization Officer (DIO) will appear automatically.
Double-check the information before submitting the form.
On submission, your request will be shared with the DIO for follow-up and scheduling
For any queries, please contact your District Immunization Officer (details will appear in the form).

School Details

School Name *

School Address *

District *

Block *

Contact Information

Principal Name *

Principal Mobile Number *

Nodal Teacher Name *

Nodal Teacher Mobile Number *

Principal Email (optional)

Fill the details

No. of Girl (Age 9–14) *

Tentative Vaccination Dates & Time *

Remarks / Comments

District Contact

District Immunization Officer

Contact Number

Email ID

School Name
Address
District
Block
Principal Name
Principal Mobile
Principal Email
Nodal Name
Nodal Mobile
Girl Children Count
Remarks
Vaccination Date 1
Vaccination Date 2
Vaccination Date 3
District Immunization Officer
Contact Number
Email