JOHN BLACSON FOUNDATION MARITIME UNIVERSITY (AREVALO), INC

Interview questions for students who have been stranded due to

COVID 19 Enhanced Community Quarantine (ECQ)

May we inform you that any data you will provide us will be used only by the JBLFMU-Arevalo purposely to
monitor and safeguard your safety while stranded in the city due to the COVID 19 ECQ.

Conforme:_______________________________ (Signature).

Name: _____________________________________ Course /Year: ________________ . Section:______________

Provincial Address: ____________________________________________ Parent’s mobile #: ________________
City Address or Boarding house where you stay:______________________________________________________
Name of Landlord/landlady: ____________________________________ HIS/HER Mobille# _________________
Source of daily sustenance while stranded in the city__________________________________________________
Reasons for staying in the city/boarding house? ______________________________________________________
Problems encountered in the boarding house due to ECQ:______________________________________________
Has the barangay extended you some assistance? Yes ( ) No ( ) what is it? ________________________
Have you received assistance from your landlord/lady? yes ( ) No ( ) what is it? ________________________
What do you plan now? A. Stay ( ) B. Go home to your residence ( )
.If you wish to go home, what could be the possible way? _____________________________________________
.If you opt to stay because of ECQ,
with whom will you derive your daily sustenance while in the city? ____________________________________

What protocols do you observe to stay safe from the COVID 19 threat?
Stay at home ( ) b. wash hands frequently ( ) c. use disinfectant ( ) d. take vitamins ( )
e. social distancing ( ) f. others ( ) pls. indicate ____________________________________