Dear Rizalian,

Greetings!

In preparation for the upcoming return to face-to-face class, the school has been preparing the campus to ensure that you are safe as mandated in the guidelines provided by the Joint Memorandum Circular No. 2021-001 (CHED and DOH): Guidelines on The Gradual Reopening of Campuses of Higher Education Institutions for Limited Face-to-Face Classes During Covid-19 Pandemic. Furthermore, limited face-to-face class meetings will only be allowed if the area has been classified as Low-Risk as declared by the IATF and the Mandaluyong City Government.

To help us in our preparations, we would like to seek your support and cooperation by responding to this survey. The information that you will share will help us in planning the preparations for the re-opening of our campus.

Please accept our sincerest appreciation for your continuous support and cooperation to ensure a safe back-to-school experience.

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* 1. Your email address will be requested and recorded when you submit this form.

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* 2. DATA PRIVACY and CONSENT

This survey is published and managed by Jose Rizal University (JRU). When designing and executing survey, it is the policy of JRU to take all necessary steps to ensure that personal information you provide is processed fairly and lawfully. All of the information that you provide will be treated as confidential and will only be used for school policy development, improvement of services and other educational purposes. Unless, you have consented, your answers and comments will not be identified as belonging to you, instead they will be combined with those gathered from other participants and will be analyzed as part of a group. We will also use your personal information and the answers you supplied in the survey to contact you for follow-up research or in conducting focus group discussions. Being part of the JRU community, your participation is necessary. However, you are entitled to ask that part, or all, of the record of your involvement in the survey be excluded or deleted. If you have any questions about this survey, you may contact us the Guidance and Testing Office at 8531-8031 local 32 or email us at guidance@jru.edu.

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* 3. Full Name of Student (Surname, First Name, Middle Name, Suffix)

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* 4. Birthdate

Date

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* 5. College Department

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* 6. Year Level

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* 7. Mobile Number

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* 8. Current Residential Address: House Number and Street Name

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* 9. Barangay

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* 10. City / Municipality

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* 11. Do you have any existing illness or comorbidity?

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* 12. Are you already vaccinated with Covid 19 vaccine?

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* 13. Do you have plans to get vaccinated?

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* 14. Are you covered by PhilHealth or any health insurance provider?

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* 15. If yes to item no. 14, please specify.

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* 16. With all the health and safety protocols in place and class sizes reduced, are you willing to attend limited face-to-face classes?

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* 17. If NO, please state your reason/s: (put a check whichever is applicable)

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* 18. (for Nursing Students only)
Are you willing to attend clinical rotation as part of your RLE course requirement? *

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