SBFP Form 1
Department of Education
Region 02
Master List Beneficiaries for School-Based Feeding Program (SBFP)
Division/Province: ISABELA Name of Principal : SAHLEE E. MIGUEL
City/ Municipality/Barangay : , LUNA, QUIRINO Name of Focal Feeding Person: TERESITA C. HERNANDO
Name of School / School District : Luna-Suerte Elem School
BMI
Date of Weighing / Age in Weight Height for 6 Nutritional Beneficiary of SBFP
No. Name Sex Date of Birth
Ethnicity Disability 4Ps ID Name of Parents
Measuring Years / y.o. in Previous Years
(MM/DD/YYYY) Months (Kg) and Status (NS) Number
(MM/DD/YYYY) (cm)
(yes or no)
above
1 Santiago, Angela C. -K F 1/14/2010 6/9/2015 6.4 13 1.04 U Ilocano none Joemar Santiago no
2 Lasam, Erich Anne T. - K F 1/23/2010 6/9/2015 6.4 13 1.02 U Ilocano none 90300007 Edmund Lasam no
3 Lasam, Charish Mae C.- K F 9/15/2009 6/9/2015 6.8 14 1.04 U Ilocano none Floren Lasam no
4 Lamorena, Prince Joemel-K M 12/22/2009 6/9/2015 6.5 19 1.11 U Ilocano none Melvin Lamorena no
5 Gemino, Genson -I M 10/3/2015 6/9/2015 9.8 13.8 1.07 12 SW Ilocano none Germinigildo Gemino yes
6 Lagutao, Ryan Jshua -I M 5/20/2009 6/9/2015 6 16 1.12 12.7 W Ilocano none Ramon Lagutao no
7 Tuliao, Noah -I M 9/11/2008 6/9/2015 6.8 17.5 1.16 13 W Ilocano none Lawrence Tuliao no
8 Andres, April Joy C. -I F 4/6/2009 6/9/2015 6.2 16.2 1.15 12.2 W Ilocano none Marivic Andres yes
9 Salazar, Alaiza Mae -I F 4/12/2009 6/9/2015 6.1 16.5 1.14 12.6 W Ilocano none Sonny Salazar no
10 Juan, John Michael - II M 5/7/2008 6/9/2015 6.9 18 112 12.8 W Ilocano none Ronie Juan no
11 Valentino, Althea Mae B.- II F 5/7/2008 6/9/2015 7.1 17.5 1.18 12.5 W Ilocano none Alberto Valentino no
12 Acosta, Carl Jhay A. - III M 9/2/2007 6/9/2015 7.9 17 1.15 12.8 W Ilocano none Roderick Acosta yes
13 Flores, Reymart L. - IV M 5/5/2006 6/9/2015 9.1 20.5 1.24 12.3 W Ilocano none Rodrigo Flores no
14 Alibuyog, Jernalyn - IV F 12/19/2006 6/9/2015 8,2 20 127 13 W Ilocano none Edwin Alibuyog no
15 Benito Paulo - VI M 4/27/2003 6/9/2015 12.1 25 1.37 13.8 W Ilocano none Herly Benito no
16 Lamorena, Jeromme-VI M 1/7/2003 6/9/2005 12.5 30 1.46 14 W Ilocano none Oliver Lamorena no
Prepared by: Noted :
TERESITA C. HERNANDO SAHLEE E. MIGUEL
Feeding Focal Person School Principal
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 ___
SCHOOL-BASED FEEDING PROGRAM (SBFP)
Division/Province: ______________________________________
City/ Municipality/Barangay : ____________________________
Name of School / School District : _________________________
Nutritional Status at Start of Feeding Ethnicity 4 Ps Beneficiaries
Number of Undernourished School
Children by Grade Level No. of No. of Pupils who
Severely No. of Total are beneficiaries in
Wasted Wasted Beneficiaries No. of Ethnic Ben. No. of 4 Ps Ben. previous years Remarks
1. Kinder
2. Grade I
3. Grade II
4. Grade III
5. Grade IV
6. Grade V
7. Grade VI
Total
Prepared by: Noted by:
______________________________________ _________________________________
SBFP DepEd Focal Unit Chief
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 3
Department of Education
Region ___
SCHOOL-BASED FEEDING PROGRAM (SBFP)
Division/Province: ______________________________________
School District/City/ Municipality : ____________________________
Name of District Total
Name of Schools BEIS ID No. School Address Name of Barangay Supervisors/ Contact Number Beneficiaries
School Principal or OICs
Prepared by: Noted by:
SBFP DepED Focal Unit Chief
Note: This form shall be prepared by the DO, for final consolidation by the RO, for submission to DSWD-FO, copy furnished DepEd-HNC
SBFP Form 4
SCHOOL-BASED FEEDING PROGRAM
FOR THE MONTHS OF OCTOIBER, 2015 - MARCH, 2016
Region 02
Division: ISABELA School: LUNA-SUERTE ELEMENTARY SCHOOL
District QUIRINO Grade: __________ Section _____________________
ACTUAL FEEDING
PRE FEEDING
4Ps
NAME OF PUPIL Beneficiary Beneficiary Nutritional Status Deworming
(y or n) of Previous Ht Wt Date Date
Age Sex (√ ) or
SBFP NS
(y or n) Birth Date cm kg Taken (X) Taken 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20
1 n n 6.4 1/14/2010 F 1.04 13 6/9/2015 U √ 7/29/2015
2 Lasam, Erich Anne T. - K n n 6.4 1/23/2010 F 1.02 13 6/9/2015 U √ 7/29/2015
3 Lasam, Charish Mae C.- K n n 6.8 9/15/2009 F 1.04 14 6/9/2015 U √ 7/29/2015
4 Lamorena, Prince Joemel-K n n 6.5 12/22/2009 M 1.11 19 6/9/2015 U √ 7/29/2015
5 Gemino, Genson -I y n 9.8 10/3/2015 M 1.07 13.8 6/9/2015 SW √ 7/29/2015
6 Lagutao, Ryan Jshua - I n n 6 5/20/2009 M 1.12 16 6/9/2015 W √ 7/29/2015
7 Tuliao, Noah -I n n 6.8 9/11/2008 M 1.16 17.5 6/9/2015 W √ 7/29/2015
8 Andres, April Joy C. -I y n 6.2 4/6/2009 F 1.15 16.2 6/9/2015 W √ 7/29/2015
9 Salazar, Alaiza Mae -I n n 6.1 4/12/2009 F 1.14 16.5 6/9/2015 W √ 7/29/2015
10 Juan, John Michael - II n n 6.9 5/7/2008 M 112 18 6/9/2015 W √ 7/29/2015
11 Valentino, Althea Mae B.- II n n 7.1 5/7/2008 F 1.18 17.5 6/9/2015 W √ 7/29/2015
12 Acosta, Carl Jhay A. - III n n 7.9 9/2/2007 M 1.15 17 6/9/2015 W √ 7/29/2015
13 Flores, Reymart L. - IV n n 9.1 5/5/2006 M 1.24 20.5 6/9/2015 W √ 7/29/2015
14 Alibuyog, Jernalyn - IV n n 8,2 12/19/2006 F 127 20 6/9/2015 W √ 7/29/2015
15 Benito Paulo - VI n n 12.1 4/27/2003 M 1.37 25 6/9/2015 W √ 7/29/2015
16 Lamorena, Jeromme-VI n n 12.5 1/7/2003 M 1.46 30 6/9/2005 W √ 7/29/2015
17
18
19
20
21
22
23
24
25
TOTAL:
Prepared by:
LEGEND
TERESITA C. HERNANDO A. Nutritional Status
B. Deworming D. Actual Feeding
Feeding Focal Person For 6-19 y.o For below 6 y.o
SW - Severely wasted SU - Severely underweight ( x ) - not dewormed ( √ ) - Present, served
W - Wasted U - Underweight ( √ ) - dewormed ( A ) - Absent, not served
N - Normal N - Normal (√√ ) - Present, served twice
Ow - Overwieght Ow - Overwieght
O - Obese
Note: This form shall be prepared by the school to be consolidated using SBFP Form 5
Page 6
SBFP Form 4
SCHOOL-BASED FEEDING PROGRAM
FOR THE MONTH OF ______________________ , SY _____________
Region ____________________________
Division ___________________________ School: _____________________________________
District ___________________________ 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 ___________________________ School: _____________________________________
District ___________________________ 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 ___________________________ School: _____________________________________
District ___________________________ Grade: __________ Section _____________________
ACTUAL FEEDING POST FEEDING
ATTENDANCE
NAME OF PUPIL Nutritional Status Days Feeding
Percentage
Ht Wt Date Present Days
101 102 ### 104 105 ### ### ### ### ### 111 112 113 114 115 116 117 118 119 120 cm kg Taken NS (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
page 4
SBFP Form 5
SCHOOL-BASED FEEDING PROGRAM
CONSOLIDATED NUTRITIONAL STATUS AND ATTENDANCE REPORT
Region: _______
Division/District: ________________________
School: ________________________________
BEIS ID No.: ___________________________
NUTRITIONAL STATUS
No. of Pupils BEFORE AFTER PERCENTAGE
GRADES AND SECTIONS
Dewormed ATTENDANCE
SW/SU W/U N Ow Ob Total SW/SU W/U N Ow O Total
1
2 karen
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 For below 6 y.o
SW - Severely Wasted SU - Severely Underweight
W - Wasted U - Underweight
N - Normal N - Normal
Ow - Overweight Ow - Overweight
O - Obese
Prepared by: Noted by:
_____________________________ ___________________________
Classroom Adviser / School Nurse School Head
Note: This form shall be prepared by the school using the data from SBFP Form 4.
