Peak Excellence Review Center, Inc.

will conduct this CHECKLIST due to the arising

concerns of your Peak classmates from out-of-town and nearby provinces. Please take time
to answer the following:

Name: JONIEREY AGUINALDO School: USM

New/ Retaker: 2ND TAKER Mobile Number: 09500304934

Review Program Enrolled:

Online Refresher only (pls check)  Tuition Fee Paid: 6,500
Blended Intensive only (pls check) ____ Tuition Fee Paid:
Package (Onsite+Blended) (pls check) __ Tuition Fee Paid:
Payment Sent thru:
Bank: _______ Name of Bank: _______________________________________
GCash: _______ Palawan: _______ Western Union: _______ Lhullier: _______

ONLINE Review:
Do you have?
 PLDT/ Regular Internet provider? (Yes) _________ (No) _________
 Data Connection only? (Yes) _________ (No) _________
 Is it available anytime? (Yes) _________ (No) _________
ONSITE Review:
Where will you stay in CDO?
 Own Residence: (Yes) _________ (No) _________
Address/Barangay of Own Residence:
 Relative’s Residence: (Yes) _________ (No) ________
Address/Barangay of Relative’s Residence:
 Boarding house rental? (Yes) ________ (No) _________
Address/Barangay of Boarding house : MOUNTAIN VIEW COLLEGE

Scheduled Date of Arrival in CDO:

Some Barangays will impose quarantine measures, are you willing to be Quarantined in CDO?
(Yes) _________ (No)

Conformed: ______________________________
Signature over Printed Name
Date: July 20, 2020