SBFP Form 1
Department of Education
Region ___
Master List Beneficiaries for School-Based Feeding Program (SBFP)
Division/Province: ______________________________________
Name of Principal : ____________________________________
City/ Municipality/Barangay : ____________________________
Name of Feeding Focal Person : _________________________
Name of School / School District : _________________________
No.
Name
Sex
Date of Birth
(MM/DD/YYYY)
Date of Weighing / Age in
Weight Height
Measuring
Years /
(Kg)
(cm)
(MM/DD/YYYY) Months
BMI for
6 y.o. Nutritional
and Status (NS)
above
Ethnicity
Disability
4Ps ID
Number
Name of Parents
Prepared by:
Noted :
__________________________________
Feeding Focal Person
_____________________________________
School Principal / Officer-in-Charge
Beneficiary of SBFP
in Previous Years
(yes or no)
Note: This form shall be prepared by the school, to be compiled by the DO, and for final compilation by the RO, for submission to DSWD-FO, copy furnished DepEd-HNC
SBFP Form 2
Department of Education
Region III
SCHOOL-BASED FEEDING PROGRAM (SBFP)
Division/Province: Tarlac Province
City/Municipality/Barangay: Gerona
Name of School/School District: Gerona North
Number of Undernourished School
Children by Grade Level
Nutritional Status at Start of Feeding
No. of
Severely
No. of
Total
Wasted
Wasted Beneficiaries No. of Ethnic Ben.
Ethnicity 4 Ps Beneficiaries
No. of 4 Ps Ben.
No. of Pupils who
are beneficiaries in
previous years
1. Kinder
13
13
2. Grade I
13
13
3. Grade II
25
25
4. Grade III
5. Grade IV
6. Grade V
27
27
7. Grade VI
15
15
107
107
11
13
Total
Prepared by:
Remarks
Noted by:
VIRGINIA N. DAGUIO
TEDDY M. JOSON
Feeding Focal Person
Principal II
Note: This form shall be prepared by the school, to be compiled by the DO, and for final compilation by the RO, for submission to DSWD-FO, copy furnished DepEdHNC
SBFP Form 3
Department of Education
Region III
SCHOOL-BASED FEEDING PROGRAM (SBFP)
Division/Province: Tarlac Province
School District/City/ Municipality : Gerona North
Name of Schools
Name of District
Name of Barangay
Supervisors/
School Principal or OICs
BEIS ID No.
School Address
Gabaldon E/S
106450
Poblacion #3, Gerona, Tarlac
Poblacion #3
Richard Melchor
Gerona North Central E/S
106451
Poblacion #3, Gerona, Tarlac
Poblacion #3
Teddy Joson
Prepared by:
Contact Number
Total
Beneficiaries
107
9477511786
Noted by:
VIRGINIA N. DAGUIO
TEDDY M. JOSON
Feeding Focal Person
Principal II
Note: This form shall be prepared by the DO, for final consolidation by the RO, for submission to DSWD-FO, copy furnished DepEd-HNC
107
SBFP Form 4
SCHOOL-BASED FEEDING PROGRAM
FOR THE MONTH OF ______________________ , SY _____________
Region ____________________________
Division ___________________________
District ___________________________
NAME OF PUPIL
4Ps
Beneficiary
Beneficiary
of Previous
(y or n)
SBFP
(y or n)
School: _____________________________________
Grade: __________ Section _____________________
ACTUAL FEEDING
PRE FEEDING
Age
Birth
Date
Sex
Ht
Nutritional Status
Wt
Date
cm
kg
Taken
NS
Deworming
( ) or Date
(X) Taken 1
9 10 11 12 13 14 15 16 17 18 19 20
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
TOTAL:
Prepared by:
LEGEND
____________________________
Feeding Teacher / School Nurse
A. Nutritional Status
For 6-19 y.o
For below 6 y.o
B. Deworming
D. Actual Feeding
SW - Severely wasted
SU - Severely underweight
( x ) - not dewormed
( ) - Present, served
W - Wasted
U - Underweight
( ) - dewormed
( A ) - Absent, not served
N - Normal
N - Normal
Ow - Overwieght
Ow - Overwieght
( ) - Present, served twice
O - Obese
Note: This form shall be prepared by the school to be consolidated using SBFP Form 5
Page 5
SBFP Form 4
SCHOOL-BASED FEEDING PROGRAM
FOR THE MONTH OF ______________________ , SY _____________
Region ____________________________
Division ___________________________
District ___________________________
School: _____________________________________
Grade: __________ Section _____________________
ACTUAL FEEDING
NAME OF PUPIL
21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 43 44 45 46 47 48 49 50 51 52 53 54 55 56 57 58 59 60
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
TOTAL:
D. Actual Feeding
( ) - Present, served
( A ) - Absent, not served
( ) - Present, served twice
page 2
SBFP Form 4
SCHOOL-BASED FEEDING PROGRAM
FOR THE MONTH OF ______________________ , SY _____________
Region ____________________________
Division ___________________________
District ___________________________
School: _____________________________________
Grade: __________ Section _____________________
ACTUAL FEEDING
NAME OF PUPIL
61 62 63 64 65 66 67 68 69 70 71 72 73 74 75 76 77 78 79 80 81 82 83 84 85 86 87 88 89 90 91 92 93 94 95 96 97 98 99 100
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
TOTAL:
D. Actual Feeding
( ) - Present, served
( A ) - Absent, not served
( ) - Present, served twice
page 3
SBFP Form 4
SCHOOL-BASED FEEDING PROGRAM
FOR THE MONTH OF ______________________ , SY _____________
Region ____________________________
Division ___________________________
District ___________________________
School: _____________________________________
Grade: __________ Section _____________________
ACTUAL FEEDING
POST FEEDING
101 102 ## 104 105 ## ## ## ## ## ## 112 113 114 115 116 117 118 119 120
Nutritional Status
Ht
Wt Date
cm
kg Taken NS
NAME OF PUPIL
ATTENDANCE
Days
Feeding
Percentage
Days
Present
(A)
(B)
(A/B)*100
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
TOTAL:
AVERAGE:
D. Actual Feeding
( ) - Present, served
( A ) - Absent, not served
( ) - Present, served twice
page 4
SBFP Form 5
SCHOOL-BASED FEEDING PROGRAM
CONSOLIDATED NUTRITIONAL STATUS AND ATTENDANCE REPORT
Region: _______
Division/District: ________________________
School: ________________________________
BEIS ID No.: ___________________________
GRADES AND SECTIONS
No. of Pupils
Dewormed
NUTRITIONAL STATUS
SW/SU
W/U
BEFORE
N
Ow
Ob
Total
SW/SU
W/U
AFTER
N
Ow
Total
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
TOTAL
AVERAGE:
Legend:
For 6-19 y.o
SW - Severely Wasted
W - Wasted
N - Normal
Ow - Overweight
O - Obese
For below 6 y.o
SU - Severely Underweight
U - Underweight
N - Normal
Ow - Overweight
Prepared by:
_____________________________
Classroom Adviser / School Nurse
Noted by:
Note: This form shall be prepared by the school using the data from SBFP Form 4.
___________________________
School Head
PERCENTAGE
ATTENDANCE
