SBFP Form 1 (2023)
Department of Education
Master List Beneficiaries for School-Based Feeding Program (SBFP) ( SY 2022-2023 )
Division: BOHOL Name of Principal :
City/ Municipality/Barangay : MARIBOJOC Name of Feeding Focal Person :
Name of School / School District : CABAWAN ELEM. SCHOOL/MARIBOJOC
School ID Number: 118537
Parent's Partici
Date of BMI
Nutritional consent pation
Date of Birth Weighing / Age in Heig for 6
Grade/ Weigh Status (NS) for milk? in 4Ps
No. Name Sex (MM/DD/YYY Measuring Years / ht y.o.
Section t (Kg)
Y) (MM/DD/YYYY Months (cm) and
(yes or (yes
) above BMI-A HFA no) or no)
1 BALA, ERNISTO A. Male Kinder 03/14/2019 8/8/2024 14 1.09 11.8 W N /
2 JABINES, CLIENTH I. Male Kinder 7/11/2018 8/8/2024 14 1.09 11.8 W N /
3 LAPUTAN, THOBEY C. Male Kinder 08/24/2019 8/8/2024 13 0.96 14.1 W S /
4 MALAYA, JOMARI G. Male Kinder 2/1/2019 8/8/2024 18 1.17 13.14 W N /
5 MICUTUAN, KURT ZYLER G. Male Kinder 03/20/2019 8/8/2024 14 1.12 11.16 W N /
6 SIGNO, REYNIEL A. Male Kinder 01/28/2019 8/8/2024 14 1.1 11.57 W N /
7 ABAPO, NOOR RAJA S. Female Kinder 03/04/2019 08/08/2024 14 1.05 12.69 W N /
8 ALBOROTO, SYRA ZIA C. Female Kinder 09/30/2019 08/08/2024 13 0.99 13.26 W N /
9 BARCINAS, CHRISSA ROSE O. Female Kinder 08/30/2019 08/08/2024 15 1.08 12.86 W N /
10 LAPUTAN, TRAVIS C. Male Grade 1 12/16/2017 08/08/2024 14 1.09 11.8 W S /
11 MONTERON, ARCHELLE P. Female Grade 1 06/19/2018 08/08/2024 13 1.03 12.2 W S /
12 MONTERON, ALBERT JR. Male Grade 2 03/02/2017 08/08/2024 15 1.08 12.8 W S /
13 AQUINO, MICHELLE Female Grade 3 10/28/2015 08/08/2024 15 1.1 12.3 W SS /
14 ANDO, RUTH MAE CAIZA Female Grade 3 12/23/2015 08/08/2024 19 1.24 12.3 W N /
15 BARGASO, HENRY Male Grade 4 08/16/2015 08/08/2024 17 1.17 12.8 W N /
16 ALABA, DIVINE GRACE Female Grade 4 09/26/2015 08/08/2024 19 1.23 12.5 W N /
17 ANINIPOT, JOHN MELGIB Male Grade 5 05/22/2013 08/08/2024 26 1.36 14 W N /
18 JABINES, JANVER Male Grade 5 02/23/2014 08/08/2024 20 1.31 11.6 SW N /
19 TAMARRA, AJ Male Grade 5 08/21/2014 08/08/2024 23 1.34 12.8 W N /
20 AMANDORON, JEAN MAYCE G. Female Grade 6 02/15/2013 08/08/2024 23 1.37 12.2 SW N /
21 GEÑOSO, JEAN M. Female Grade 6 12/11/2012 08/08/2024 25 1.38 13.1 W N /
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Approved by:
LAARNI R. ALEJANDRO
School Head
Beneficiary
of SBFP in
Previous
Years (yes
or no)
No
No
No
No
No
No
No
No
No
No
No
No
No
No
No
No
No
No
No
No
No
Department of Education
SBFP Form 2 (2023)
SCHOOL-BASED FEEDING PROGRAM (SBFP) SUMMARY OF BENEFICIARIES & START OF FEEDING (SY_:2023-2024_)
Schools Division Office: ________________
City/ Municipality/Barangay : ____________________________
Name of School / School District : _________________________
School ID Number: _________________________
Date of Start of Feeding: __________________________
Last Mile School: ___Y ___N
Nutritional Status at Start/End of Feeding No. of Secondary Targets
Number of
Undernourished School Overweight No. of Pupils-at- No. of
Children by Grade Sex Severely Severely risk-of-
No. of
Stunted/ Indigent
Wasted Normal + Stunted Normal Tall
Level Wasted Stunted dropping-out Severely
Learners
Obese (PARDOs) Stunted
M 0 6 4 0 0 1 9 0 0 0 0
1. Kinder F 0 3 9 0 0 0 12 0 0 0 0
Total 0 9 13 0 0 1 21 0 0 0 0
M 0 1 7 0 0 1 7 0 0 0 0
2. Grade I F 0 1 6 0 0 1 6 0 0 0 0
Total 0 2 13 0 0 2 13 0 0 0 0
M 0 1 15 0 0 1 15 0 0 0 0
3. Grade II F 0 0 11 0 0 0 11 0 0 0 0
Total 0 1 26 0 0 1 26 0 0 0 0
M 0 0 6 0 0 0 6 0 0 0 0
4. Grade III F 0 2 13 0 1 0 14 0 0 0 0
Total 0 2 19 0 1 0 20 0 0 0 0
M 0 1 9 0 0 0 10 0 0 0 0
5. Grade IV F 0 1 6 0 0 0 7 0 0 0 0
Total 0 2 15 0 0 0 17 0 0 0 0
M 1 2 16 0 0 0 19 0 0 0 0
6. Grade V F 0 0 14 0 0 0 14 0 0 0 0
Total 1 2 30 0 0 0 33 0 0 0 0
M 0 0 9 0 0 0 9 0 0 0 0
7. Grade VI F 1 1 13 0 0 0 15 0 0 0 0
Total 1 1 22 0 0 0 24 0 0 0 0
M 1 11
Grand Total F 1 7
Total 2 19 138 0 1 4 154 0 0 0 0
Prepared by: Approved by:
SBFP DepEd Focal School Head
Note: This form shall be prepared by the school before the start of feeding and after feeding, to be compiled by the SDO, and for final compilation by the RO, for subm
G (SY_:2023-2024_)
dary Targets
No. of Pupils Date
No. of No. of 4 No. of 4 Ps who are Feeding
Learners Beneficiari beneficiaries in
Indigenou Dewormed es previous years Started/En
s Peoples (Repeaters) ded
(IPs)
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0 0 0 0
School Head
ompilation by the RO, for submission to DepEd BLSS-SHD
SBFP Form 3 (2023)
SCHOOL-BASED FEEDING PROGRAM
RECORD OF DAILY FEEDING
FOR THE MONTH OF _________________, SY 2024-2025
Region: IV - A CALABARZON
SDO: RIZAL School: PIPINDAN ELEMENTARY SCHOOL
District: BINANGONAN School ID Number: 10
Grade: __________ Section _____________________
NFP ACTUAL FEEDING
NAME OF PUPIL SEX
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20
Prepared by:
EUGENE D. FERMIN
B. Deworming D. Actual Feeding
SBFP COORDINATOR
( x ) - not dewormed (H ) - Present, served with Hot meals
Approved by: ( √ ) - dewormed (M ) - Present, served with Milk
(H/M ) - Present, served with Hot meals & Milk
ABIGAIL T. ARADA ( A ) - Absent, not served
School Head (H2/M2/(H/M2)) - Present, served twice
NFP ACTUAL FEEDING
NAME OF PUPIL SEX
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20
Prepared by:
EUGENE D. FERMIN
B. Deworming D. Actual Feeding
SBFP COORDINATOR
( x ) - not dewormed (H ) - Present, served with Hot meals
Approved by: ( √ ) - dewormed (M ) - Present, served with Milk
(H/M ) - Present, served with Hot meals & Milk
ABIGAIL T. ARADA ( A ) - Absent, not served
School Head (H2/M2/(H/M2)) - Present, served twice
SBFP Form 5 (2020)
SBFP Form 4 (2023)
DEPARTMENT OF EDUCATION
REGION/SDO/DISTRICT:
NAME OF SCHOOL:
SCHOOL ID NO.:
SCHOOL-BASED FEEDING PROGRAM - MILK COMPONENT
LIST OF AUTHORIZED CONSIGNEES (SY: 2024-2025)
NAME & DESIGNATION TEL. NO. MOBILE NO. EMAIL ADD SPECIMEN
SIGNATURE
1
SCHOOL INSPECTION TEAM (SY: (2024-2025)
NAME & DESIGNATION TEL. NO. MOBILE EMAIL ADD SPECIMEN
NO. SIGNATURE
1
Note: Only authorized consignees are allowed to receive the goods.
Use long hand signature.
SBFP Form 5 (2021)
SBFP Form 5 (2023)
DEPARTMENT OF EDUCATION
CAR
REGION/DIVISION/DISTRICT: ____________ VII/BOHOL/MARIBOJOC
NAME OF SCHOOL: _______ CABAWAN ELEMENTARY SCHOOL
SCHOOL ID NO.: _____ 118537
SCHOOL-BASED FEEDING PROGRAM - MILK COMPONENT
LIST OF BENEFICIARIES (SY 2023-2024)
Classification of Students in terms of Milk Tolerance (Please check one)
Without milk intolerance With milk intolerance but
Name Sex Grade & Section Not allowed by parents to
and will participate in milk willing to participate in milk
participate in milk feeding
feeding feeding
1 BALA, ERNISTO A. Male Kinder /
2 JABINES, CLIENTH I. Male Kinder /
3 LAPUTAN, THOBEY C. Male Kinder /
4 MALAYA, JOMARI G. Male Kinder /
5 MICUTUAN, KURT ZYLER G. Male Kinder /
6 SIGNO, REYNIEL A. Male Kinder /
7 ABAPO, NOOR RAJA S. Female Kinder /
8 ALBOROTO, SYRA ZIA C. Female Kinder /
9 BARCINAS, CHRISSA ROSE O. Female Kinder /
10 LAPUTAN, TRAVIS C. Male Grade 1 /
11 MONTERON, ARCHELLE P. Female Grade 1 /
12 MONTERON, ALBERT JR. Male Grade 2 /
13 AQUINO, MICHELLE Female Grade 3 /
14 ANDO, RUTH MAE CAIZA Female Grade 3 /
15 BARGASO, HENRY Male Grade 4 /
16 ALABA, DIVINE GRACE Female Grade 4 /
17 ANINIPOT, JOHN MELGIB Male Grade 5 /
18 JABINES, JANVER Male Grade 5 /
19 TAMARRA, AJ Male Grade 5 /
20 AMANDORON, JEAN MAYCE G. Female Grade 6 /
SBFP Form 5 (2021)
21 GEÑOSO, JEAN M. Female Grade 6 /
Prepared by: APPROVED BY:
School Feeding Coordinator School Head
SBFP Form 6 (2021)
SBFP Form 6 (2023)
DEPARTMENT OF EDUCATION
REGION/DIVISION/DISTRICT: ______________________________________________________________________________
NAME OF SCHOOL: ______________________________________________________________________________
SCHOOL ID NO.: ______________________________________________________________________________
SCHOOL-BASED FEEDING PROGRAM
NFP DELIVERIES (SY 2023-2024)
Grade Level Sex Number of Beneficiaries Date Delivered No. of Packs Received No. of Packs for Remarks
Replacement/ Rejected
New Replacement Total (New +
Replacement)
Kinder
M
Total 0
Grade 1 M
Total 0
Grade 2 M
Total 0
Grade 3 M
Total 0
Grade 4 M
F
SBFP Form 6 (2021)
Total 0
Grade 5 M
Total 0
Grade 6 M
Total 0
GRAND TOTAL:
F
Total 0
Prepared by:
APPROVED BY:
School Feeding Coordinator
School Head
MILK DELIVERIES (SY 2023-2024)
Grade Level Sex Number of Beneficiaries Date Delivered No. of Packs Received No. of Packs for Remarks
Replacement/ Rejected
New Replacement Total (New +
Replacement)
Kinder
M
Total 0
SBFP Form 6 (2021)
Grade 1 M
Total 0
Grade 2 M
Total 0
Grade 3 M
Total 0
Grade 4 M
Total 0
Grade 5 M
Total 0
Grade 6 M
Total 0
GRAND TOTAL: F
Total 0
Prepared by: APPROVED BY:
SBFP Form 6 (2021)
School Feeding Coordinator School Head
