Department of Education
Region I
Name of School / School District : General Gregorio Del Pilar Elementary School / District III
No.
Name
Sex
Date of
Date of Birth
Weighing /
(MM/DD/YYY
Measuring
Y)
(MM/DD/YYYY
)
Age in
Years /
Months
Weight
(Kg)
Height
(cm)
6/16/2015
60 mos
13
1/13/2010 6/16/2015
65 mos
14
6/16/2015
64 mos
14
1/24/2010 6/16/2015
64 mos
13
Disabil
ity
4Ps ID
Number
Ethnicity
Name of Parents
1.05
Underweight
Pangasinense
Ofelia R. Manangan
0.96
Underweight
Pangasinense
Rebecca G. Bianan
No
1.08
Underweight
Pangasinense
Aderida C. Manaois
No
1.05
Severely Underweight
Pangasinense
Martina D. Milo
No
Merly Forteza
No
1 Aquino, Tyron M.
2 Manalo, Maryllee B.
5 Villanueva, Alexander Q.
###
6/16/2015
6,6
16
1.12
Wasted
Pangasinense
9/5/2010
6/16/2015
57 mos
12
1.02
Underweight
Pangasinense
7 Generao, Jasmine S.
56 mos
13
1.02
Underweight
Pangasinense
Regilyn M. Generao
No
###
6/16/2015
66 mos.
14
1.07
Underweight
Pangasinense
Cristie E. Paras
No
9 Santos, Romma G.
7/7/2010
6/16/2015
59 mos
12
Severely Underweight
Pangasinense
Rebecca G. Bianan
No
7/11/2010 6/16/2015
59 mos
0.98
Severely Underweight
Pangasinense
Jennifer N. Torio
No
11 Ventenilla, Rhianne S.
9/10/2010 6/16/2015
57 mos
12
0.98
Underweight
Pangasinense
Diana A. Ventenilla
No
12 Vidal, Danica Z.
7/20/2010 6/16/2015
58 mos
12
Underweight
Pangasinense
Diana Z. Vidal
No
8/29/2009 6/16/2015
69 mos.
14
1.06
Underweight
Pangasinense
Nielda J. Zamora
No
14 Agillo,
3/10/2010 6/16/2015
Angelo
16 Quinones, Roel M.
17 Vidal, Rickyen C.
6/7/2010
BMI for 6
y.o. and
above
Beneficia
ry of
SBFP in
Previous
Years
(yes or
no)
2/5/2010
9/22/2010 6/16/2015
No
No
63 mos
14
Underweight
Pangasinense
Rodamine Surbano
No
6/16/2015
65 mos
14
1.08
Underweight
Pangasinense
Joseph Javier
No
9/22/2009 6/16/2015
68 mos
15
1.05
Underweight
Pangasinense
Rogelio Z. Quinones
No
6/16/2015
65 mos
13
Severely Underweight
Pangasinense
Ricky D. Vidal
No
###
###
8/19/2009 6/16/2015
69 mos.
14
1.01
Underweight
Pangasinense
No
3/11/2010 6/16/2015
63 mos
14
1.01
Underweight
Pangasinense
Randall Abejuela
No
9/26/2010 6/16/2015
56 mos
11
0.97
Severely Underweight
Pangasinense
Jennifer Soria
No
22 Samson, Venedick S.
23 Arenas, Princess L.
4/20/2009 6/16/2015
24 Cruz, Apple P.
26 Jimenez, Angeline
###
6/16/2015
###
28 Mirong, Jamaica S.
###
6/16/2015
66 mos.
12
0.99
Severely Underweight
Pangasinense
Marissa Pastor
No
###
6/16/2015
55 mos
13
0.92
Underweight
Pangasinense
Rosario Samson
No
6,1
13
1.05
Wasted
Pangasinense
Virginia Arenas
No
3/25/2010 6/16/2015
62 mos
12
0.94
Severely Underweight
Pangasinense
Alma Cruz
No
6/30/2010 6/16/2015
59 mos
12
0.96
Severely Underweight
Pangasinense
No
65 mos
14
1.02
Underweight
Pangasinense
Kathlyn Jimenez
No
6/16/2015
55 mos
13
0.98
Underweight
Pangasinense
Diana Landingin
No
2/14/2010 6/16/2015
64 mos
12
0.94
Severely Underweight
Pangasinense
Jasmine Mirong
No
3/27/2010 6/16/2015
62 mos
13
0.99
Underweight
Pangasinense
Michelle Parayaoan
No
30 Rizarre, Jennalyn F.
6/12/2010 6/16/2015
60 mos
12
0.97
Severely Underweight
Pangasinense
Rosalyn Rizarre
No
9/24/2010 6/16/2015
56 mos
13
1.01
Underweight
Pangasinense
May Lopez
No
32 Manuel, Marlon S.
6/16/2015
69 mos.
15
Underweight
Pangasinense
Madonna Manuel
No
9/27/2009 6/16/2015
68 mos
14
1.08
Underweight
Pangasinense
9/7/2009
No
No.
Name
Sex
Date of
Date of Birth
Weighing /
(MM/DD/YYY
Measuring
Y)
(MM/DD/YYYY
)
###
Age in
Years /
Months
Weight
(Kg)
Height
(cm)
6/16/2015
56 mos
13
BMI for 6
y.o. and
above
Ethnicity
Underweight
Pangasinense
Disabil
ity
4Ps ID
Number
Name of Parents
34 Bagay, Kristine G.
35 Gabriel, Maria
9/21/2010 6/16/2015
56 mos
13
Underweight
Pangasinense
Aurora Gabriel
No
36 Jimenez, Jasmine
5/25/2010 6/16/2015
60 mos
13
1.02
Underweight
Pangasinense
Kimberly Jimenez
No
6/16/2015
55 mos
11
0.94
Severely Underweight
Pangasinense
5/28/2010 6/16/2015
60 mos
11
Severely Underweight
Pangasinense
5/24/2010 6/16/2015
60 mos
12
1.02
Severely Underweight
Pangasinense
9/7/2009
6/15/2015
69mos.
15
1.06
Wasted
Pangasinense
Christine O. Collado
No
###
6/15/2015
67 mos.
15
1.02
Wasted
Pangasinense
No
15
1.13
Severely Underweight
Pangasinense
Philip Mores
No
###
6/15/2015
66 mos.
14
1.05
Wasted
Pangasinense
Alejandro Alon
No
7/7/2009
6/15/2015
71 mos.
15
1.17
Wasted
Pangasinense
Rowena S. Mejia
No
###
6/15/2015
6,6
14
1.16
10.4
Severely Underweight
Pangasinense
Yes
10/3/2009 6/15/2015
68 m0s.
14
1.08
Wasted
Pangasinense
Franco Caballero
No
4/18/2009 6/15/2015
6.1
16
1.16
11.8
Severely Wasted
Pangasinense
Enrique Doloque
Yes
48 Garcia, Matthew U.
6/15/2008 6/15/2015
7,0
16
1.13
12.5
Wasted
Pangasinense
Leitrenitz Garcia
No
49 Lazo, Reggie J.
6,3
10
0.97
10.6
Severely Underweight
Pangasinense
Rito Lazo
No
50 Nacorda, Arjay D.
2/19/2009 6/15/2015
6,3
16
1.14
12.3
Wasted
Pangasinense
Eddie Nacorda
No
51 Anol, Charlina P.
6/25/2009 6/15/2015
71 MOS.
15
1.O3
Wasted
Pangasinense
Carl Anol
No
52 Simbulan, Chloe G.
###
6/15/2015
6,5
15
1.12
11.9
Wasted
Pangasinense
Christopher Simbulan
No
2/8/2009
6/15/2015
6,4
17
1.17
12.4
Wasted
Pangasinense
No
54 Fernandez, Danilo P.
###
6/15/2015
7,7
17
1.14
13
Wasted
Pangasinense
Mercy Fernandez
No
55 Mamaril,Jobert Z.
2/9/2008
6/15/2015
7,4
15
1.09
12.6
Wasted
Pangasinense
No
56 Paras, Noah L.
3/17/2009 6/15/2015
6,2
15
1.1
12.3
Wasted
Pangasinense
Miriam Loresco
Yes
57 Paras, Rino F.
1/9/2008
6/16/2015
7,5
19
1.2
13.1
Wasted
Pangasinense
9/9/2008
6/15/2015
6,9
15
1.13
11.7
Severely Underweight
Pangasinense
Rossana Prasmo
No
###
6/15/2015
67 mos.
15
1.08
Wasted
Pangasinense
Nancy Laudencio
No
60 Ferrer, Zyrene A.
8/5/2009
6/15/2015
70 mos.
14
1.02
Wasted
Pangasinense
No
###
3/11/2009 6/15/2015
3/6/2009
6/15/2015
Arlene Bagay
Beneficia
ry of
SBFP in
Previous
Years
(yes or
no)
No
No
Esmeralda Narag
No
No
35295767
No
61 Zabala, Rhianne
9/10/2009 6/15/2015
69 mos.
14
0.96
Wasted
Pangasinense
62 Almonte, Alwyne R.
5/21/2008 6/19/2015
7,0
17
1.16
12.6
Wasted
Pangasinense
Alexander L. Almonte
No
63 Camacho, Elijah
7,3
18
1.18
12.9
Wasted
Pangasinense
Alfreda C. Camacho
No
7/16/2008 6/19/2015
6,11
16
1.17
11.6
Severely Wasted
Pangasinense
Rhodora I. Macatiag
No
65 Munar, Arnold
10/1/2007 6/19/2015
7,8
19
1.2
13.1
Wasted
Pangasinense
Arnold M. Munar
No
9/15/2005 6/17/2015
9,9
17
1.17
12.4
Severely Wasted
Pangasinense
Marivic Ceralde
No
1/27/2007 6/17/2015
8,4
16
1.1
13.2
Wasted
Pangasinense
Mayet Clores
No
68 De Leon Jiel P.
9/30/2008 6/17/2015
6,8
17
1.14
13
Wasted
Pangasinense
Ryan De Leon
No
69 Mabalot, Justine C.
70 Mirong, Joshua G.
7/9/2008
72 De la Cruz, Angelica
###
3/5/2008
1/3/2007
6/19/2015
6/17/2015
No
35317616
8,5
17
1.13
13.3
Wasted
Pangasinense
Arlene Mabalot
No
6,11
15
1.08
12.8
Wasted
Pangasinense
Jocelyn Pastor
No
6/17/2015
6,11
14
1.06
12.4
Wasted
Pangasinense
Marissa Pastor
No
6/17/2015
7,6
16
1.13
12.5
Wasted
Pangasinense
No
4/10/2008 6/17/2015
7,2
16
1.14
12.3
Wasted
Pangasinense
6/29/2008 6/17/2015
35093171
No
No.
Name
74 Ferrer, Princess A.
Sex
Date of
Date of Birth
Weighing /
(MM/DD/YYY
Measuring
Y)
(MM/DD/YYYY
)
Age in
Years /
Months
Weight
(Kg)
Height
(cm)
BMI for 6
y.o. and
above
Ethnicity
Disabil
ity
4Ps ID
Number
Name of Parents
Beneficia
ry of
SBFP in
Previous
Years
(yes or
no)
###
6/17/2015
7,6
18
1.2
12.5
Wasted
Pangasinense
Jennifer Ferrer
75 Gaspar, Jamila R.
8/8/2008
6/17/2015
6,10
18
1.21
12.2
Wasted
Pangasinense
Maria Gaspar
No
###
6/16/2015
7,6
18
1.17
13.1
Wasted
Pangasinense
Marvin Forca
No
77 Dolorico, Regielsa D.
2/3/2008
6/16/2015
7,4
16
1.16
11.8
Wasted
Pangasinense
Reggie Dolorico
No
78 Luceriana, Carmina N.
3/7/2008
6/16/2015
7,3
18
1.19
12.7
Wasted
Pangasinense
Christopher Luceriana
No
79 Caballero, Christian B.
7,11
16
1.11
12.9
Wasted
Pangasinense
Julie B. Caballero
No
80 Maragana, Angelo E.
10,7
24
1.32
13.7
Wasted
Pangasinense
Ginalyn E. Maragana
Yes
7/14/2007 6/17/2015
###
6/15/2015
###
6/15/2015
6/27/2004 6/16/2015
35612537
No
7,8
16
1.18
11.4
Severely Wasted
Pangasinense
Rhoda A. Sembrana
No
10,11
19
1.21
12.9
Severely Wasted
Pangasinense
Renante R. Lumban
No
###
6/16/2015
8,8
16
1.13
12.5
Wasted
Pangasinense
Renato Veloso
No
3/4/2007
6/17/2015
8,3
16
1.16
11.8
Severely Wasted
Pangasinense
Isidro Pedrones
No
85 Luna, Angel A.
3/23/2007 6/17/2015
8,2
15
1.17
10.9
Severely Wasted
Pangasinense
Anna Luna
No
###
35188992
6/17/2015
9,7
18
1.2
12.5
Wasted
Pangasinense
Edgar Mercado
No
6/17/2006 6/17/2015
9,0
22
1.28
13.4
Wasted
Pangasinense
Criselda Casana
No
7/23/2005 6/17/2015
9,10
22
1.31
12.8
Wasted
Pangasinense
Juvelyn Nicolas
No
9/11/2006 6/17/2015
8,9
22
1.3
13
Wasted
Pangasinense
Editha Viray
No
1/8/2004
35292783
6/17/2015
11,5
28
1.44
13.5
Wasted
Pangasinense
Perla Dacer
No
1/15/2004 6/16/2015
11,5
20
1.27
12.4
Severely Wasted
Pangasinense
Marivic Abulencia
No
12/1/2005 6/16/2015
9,6
22
1.32
12.6
Severely Wasted
Pangasinense
Shiela Cayoyong
No
6/10/2006 6/16/2015
9,0
21
1.25
13.4
Wasted
Pangasinense
Jenalyn
No
6/21/2006 6/16/2015
8,11
20
1.24
13
Wasted
Pangasinense
Sharnie Manalo
No
2/13/2006 6/16/2015
9,4
20
1.27
12.4
Wasted
Pangasinense
Gina Narcorda
No
96 Bianan, Leiu D.
11/7/2003 6/17/2015
11,7
23
1.32
13.2
Wasted
Pangasinense
Rebecca Bianan
No
9/17/2005 6/17/2015
9,9
21
1.27
13
Wasted
Pangasinense
Teofilo Jovellanos
No
6/2/2006
6/17/2015
9,0
19
1.2
13.1
Wasted
Pangasinense
Crisanto Santillan
No
99 Aquino, Marcilo S.
###
6/19/2015
11,6
20
1.21
13.6
Wasted
Pangasinense
43383224
Mario Aquino
Yes
35115060
No
Yes
35197777
Fallorin
12/2/2004 6/19/2015
10,6
21
1.23
13.8
Wasted
Pangasinense
3/24/2003 6/16/2015
12,2
27
1.39
13.9
Wasted
Pangasinense
###
6/16/2015
9,7
22
1.3
13
Wasted
Pangasinense
###
6/16/2015
10,7
22
1.3
13
Wasted
Pangasinense
9/30/2005 6/16/2015
9,8
25
1.36
13.5
Wasted
Pangasinense
No
3/29/2005 6/16/2015
10,2
25
1.39
12.9
Wasted
Pangasinense
Angelita De Leon
No
10,7
23
1.29
13.8
Wasted
Pangasinense
Analyn B. Paras
No
7/27/2004 6/16/2015
10,10
25
1.35
13.7
Wasted
Pangasinense
Rowena Yao
No
12/7/2004 6/16/2015
10,6
21
1.33
11.8
Severely Wasted
Pangasinense
Victorina Ampalayan
No
3/28/2005 6/16/2015
10,2
20
1.22
13.4
Wasted
Pangasinense
Jomar Delima
No
1/29/2003 6/16/2015
12,4
22
1.24
14.3
Wasted
Pangasinense
Mark Manuel
No
2/17/2005 6/16/2015
10,3
25
1.35
13.7
Wasted
Pangasinense
Abraham Millan
No
3/22/2004 6/16/2015
11,2
23
1.31
13.4
Wasted
Pangasinense
Jolleylen Forca
No
7/27/2004 6/16/2015
10,10
25
1.35
13.7
Wasted
Pangasinense
Angela Meneses
No
###
6/16/2015
No
No
35314221
35616132
No.
Name
Sex
Date of
Date of Birth
Weighing /
(MM/DD/YYY
Measuring
Y)
(MM/DD/YYYY
)
Age in
Years /
Months
Weight
(Kg)
Height
(cm)
BMI for 6
y.o. and
above
Ethnicity
Disabil
ity
4Ps ID
Number
###
6/16/2015
9,7
22
1.3
13
Wasted
Pangasinense
###
6/16/2015
9,7
21
1.28
12.8
Wasted
Pangasinense
###
6/16/2015
11,5
24
1.31
13.9
Wasted
Pangasinense
35304157
2/10/2004 6/16/2015
11,4
24
1.34
13.3
Wasted
Pangasinense
35085314
8/19/2005 6/16/2015
9,9
21
1.27
13
Wasted
Pangasinense
9/30/2005 6/16/2015
9,8
20
1.3
11.8
Severely Wasted
Pangasinense
Donna Oraya
No
10/6/2003 6/16/2015
11,8
24
1.34
13.3
Wasted
Pangasinense
Nenita Rayos
No
2/3/2005
6/16/2015
10,4
19
1.21
12.9
Wasted
Pangasinense
Jimly Sevidal
No
###
6/16/2015
10,7
21
1.31
12.2
Severely Wasted
Pangasinense
Lourdes Sison
No
8/7/2003
6/16/2015
11,10
29
1.47
13.4
Wasted
Pangasinense
Rolando Valdez
No
###
6/16/2015
10,7
23
1.3
13.6
Wasted
Pangasinense
Alma Castres
No
9/21/1999 6/16/2015
15,8
48
1.86
13.8
Severely Wasted
Pangasinense
Sandra Javier
No
7/15/1999 6/16/2015
15,11
31
1.45
14.7
Wasted
Pangasinense
Marilou Caballero
No
3/10/2000 6/16/2015
15,3
32
1.5
14.2
Severely Wasted
Pangasinense
Francisco Ceralde
No
1/26/2003 6/16/2015
12,4
25
1.33
14.1
Wasted
Pangasinense
Joel Mina
No
3/1/2003
6/17/2015
12,3
26
1.36
14
Wasted
Pangasinense
1/4/2003
6/17/2015
12,5
23
1.29
13.8
Wasted
Pangasinense
3/5/2003
6/17/2015
12,3
33
1.53
14
Wasted
###
6/17/2015
11,7
20
1.23
13.2
3/12/2002 6/17/2015
13,3
25
1.34
13.9
5/11/2002 6/16/2015
13,1
32
1.47
1/23/2002 6/16/2015
13,4
27
11,5
22
###
6/16/2015
35301307
Name of Parents
35610766
Marlene Paras
Beneficia
ry of
SBFP in
Previous
Years
(yes or
no)
No
Joanne Trinidad
No
Mirasol Vidal
No
Vilma Doloque
No
Emilyn Serafica
No
35187421
Joven Mejia
No
Rito Lazo
Yes
Pangasinense
Gilbert Cervera
No
Wasted
Pangasinense
Rogelio Paras
No
Wasted
Pangasinense
Cesar Paras
No
14.8
Wasted
Pangasinense
Edward Bautista
No
1.41
13.5
Severely Wasted
Pangasinense
Marcelino Tamayo
No
1.27
13.6
Wasted
Melchor Garcia
Yes
Pangasinense
35295630
35267308
Noted :
LORENA G. CALMA
Feeding Focal Person
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 I
Number of Undernourished
No. of
School Children by Grade
Severely
Level
who are
Total
beneficiaries
BeneficiariNo. of Ethnic Ben.
No. of 4 Ps Ben. in previous
es
years
Wasted
No. of
Wasted
1. Kinder
13
26
39
2. Grade I
17
22
3. Grade II
16
18
4. Grade III
5. Grade IV
12
14
6. Grade V
19
22
7. Grade VI
11
14
32
104
136
24
Total
Prepared by:
LORENA G. CALMA
SBFP DepEd Focal
Remarks
Noted by:
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 ___
Name of Schools
BEIS ID No.
School Address
Prepared by:
Name of District
Total
Supervisors/
Name of Barangay
Contact Number Beneficiari
School Principal
es
or OICs
Noted by:
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
NAME OF PUPIL
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
26
27
28
29
30
31
32
33
34
35
36
Arenas, Jeayea P.
Sembrana, Honey Khae
Paras, Noah
Reyes, Dexter
Bernardez Jr. Eduardo M.
De Guzman, Melvin P.
Doloque, John Patrick
Calleja, San Joe E.
Panganiban, Alexander James S.
De Guzman, Mark V.
Vidal, Anthonette Gel DC.
Veloso, Gizl P.
Calupit, Ashley
Abule, Rhencel L.
Capinpin, Princess Mae P.
Narag, Jasmin
Munar, Shanelle Irish C.
Maragana, Angelo E.
Dela Cruz, Jessalyn Joy L.
Yao, Jerome V.
Mercado, Edra Jane
Samson, Juvelyn S.
Aquino, Marcilo S.
Vidal, Elizabeth F.
Arguelles, John Wayne C.
Reyes, Kassandra Kyle
Ampalayan, Aldrin M.
Toralba, Jesus Gabrielle C.
Paras, Clarissa S.
Carrera, Cindy
Corbillon, Christian F.
Lazo, Ruwei J.
Veloso, Remedios P.
Gutierrez, Wilfred S.
Garcia, Paula V.
Labrador, Normie Lea P.
4Ps
Benefi Beneficia
ciary
ry of
(y or Previous
n)
SBFP
(y or n)
ACTUAL FEEDING
PRE FEEDING
Age
Ht
Nutritional Status
Wt
Date
cm
kg
Taken
0.95
11
6/11/2014
SU
Sex
Birth Date
53 mos.
10/3/2009
NS
61 mos.
5/6/2009
1.02
11
6/11/2014
SU
65 mos.
12/12/2008
1.03
12
6/11/2014
SU
64 mos.
1/28/2009
1.05
12
6/11/2014
SU
66 mos.
11/16/2008
13
6/11/2014
SU
61 mos.
4/21/2009
1.08
12
6/11/2014
SU
63 mos.
2/13/2009
1.06
11
6/11/2014
SU
61 mos.
5/2/2009
1.04
14
6/11/2014
62 mos.
3/26/2009
0.99
12
6/11/2014
SU
60 mos.
5/18/2009
0.96
13
6/11/2014
66 mos.
11/25/2008
1.1
14
6/11/2014
68 mos.
9/20/2008
0.96
13
6/6/2014
SW
6,6
11/11/2007
10.7
17
6/6/2014
SW
69 mos.
8/28/2008
1.06
13
6/6/2014
SW
71 mos.
6/12/2008
0.98
11
6/6/2014
SW
71 mos.
6/9/2008
1.03
13
6/6/2014
SW
7,4
1/23/2007
1.15
17
6/9/2014
SW
9,7
10/16/2004
1.28
19
6/9/2014
SW
11,10
8/6/2002
1.98
40
6/9/2014
SW
8,4
1/17/2006
1.14
17
6/9/2014
8,7
10/27/2005
1.16
17
6/9/2014
7,11
6/12/2006
1.32
20
6/9/2014
SW
10,6
11/28/2003
1.18
17
6/9/2014
SW
8,0
5/15/2006
1.2
18
6/9/2014
7,8
9/20/2006
1.21
19
6/9/2014
9,9
9/8/2004
1.36
22
6/10/2014
SW
9,6
12/7/2004
1.3
19
6/10/2014
SW
9,2
3/24/2005
1.35
22
6/10/2014
SW
9,10
7/26/2004
1.32
21
6/10/2014
SW
12,6
11/21/2001
1.45
25
6/10/2014
SW
12,3
2/26/2002
1.37
25
6/6/2014
SW
11,5
1/6/2003
1.26
20
6/6/2014
SW
11,0
6/6/2003
1.45
25
6/6/2014
SW
11,2
3/29/2003
1.21
19
6/6/2014
SW
10,5
12/28/2003
1.24
19
6/6/2014
SW
10,6
11/22/2003
1.18
17
6/6/2014
SW
Y
Y
Deworming
( ) or Date 23
(X) Taken 1
Page 8
24
25
26
29
30
10
13
14
15
16
17
20
21
10
11
12
13
14
15
16
17
18
19
20
SBFP Form 4
SCHOOL-BASED FEEDING PROGRAM
NAME OF PUPIL
37
38
39
40
4Ps
Benefi Beneficia
ciary
ry of
(y or Previous
n)
SBFP
(y or n)
Vidal, Angelica
Cabalar, Carlos Jonel V.
Tamayo, Marlon D.
Aquino, Benjie V.
Age
Sex
Birth Date
11,7
Y
ACTUAL FEEDING
PRE FEEDING
Ht
Nutritional Status
Wt
Date
cm
kg
Taken
NS
10/22/2002
1.36
24
6/10/2014
SW
12,0
6/2/2002
1.42
24
6/9/2014
SW
14,5
12/22/1999
1.5
31
6/9/2014
SW
14,6
11/14/1999
1.42
30
6/9/2014
Deworming
( ) or Date 23
(X) Taken 1
24
25
26
29
30
10
13
14
15
16
17
20
21
10
11
12
13
14
15
16
17
18
19
20
TOTAL:
Prepared by:
LEGEND
LORENA G. CALMA
Feeding Teacher / School Nurse
A. Nutritional Status
For 6-19 y.o
B. Deworming
D. Actual Feeding
SW - Severely wasted
SU - Severely underweight
( x ) - not dewormed
( ) - Present, served
W - Wasted
U - Underweight
( ) - dewormed
N - Normal
N - Normal
Ow - Overwieght
Ow - Overwieght
O - Obese
Note: This form shall be prepared by the school to be consolidated using SBFP Form 5
Page 9
SBFP Form 4
SCHOOL-BASED FEEDING PROGRAM
ACTUAL FEEDING
NAME OF PUPIL
22 23 27 28 29 30 31 3 4 5 6 7 10 11 12 14 17 18 19 20 21 24 25 26 27 28 1 2 3 4 5 8 9 10 11 12 15
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
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
26
27
28
29
30
31
32
33
34
35
36
Arenas, Jeayea P.
Sembrana, Honey Khae
Paras, Noah
Reyes, Dexter
Bernardez Jr. Eduardo M.
De Guzman, Melvin P.
Doloque, John Patrick
Calleja, San Joe E.
Panganiban, Alexander James S.
De Guzman, Mark V.
Vidal, Anthonette Gel DC.
Veloso, Gizl P.
Calupit, Ashley
Abule, Rhencel L.
Capinpin, Princess Mae P.
Narag, Jasmin
Munar, Shanelle Irish C.
Maragana, Angelo E.
Dela Cruz, Jessalyn Joy L.
Yao, Jerome V.
Mercado, Edra Jane
Samson, Juvelyn S.
Aquino, Marcilo S.
Vidal, Elizabeth F.
Arguelles, John Wayne C.
Reyes, Kassandra Kyle
Ampalayan, Aldrin M.
Toralba, Jesus Gabrielle C.
Paras, Clarissa S.
Carrera, Cindy
Corbillon, Christian F.
Lazo, Ruwei J.
Veloso, Remedios P.
Gutierrez, Wilfred S.
Garcia, Paula V.
Labrador, Normie Lea P.
page 2
SBFP Form 4
SCHOOL-BASED FEEDING PROGRAM
ACTUAL FEEDING
NAME OF PUPIL
22 23 27 28 29 30 31 3 4 5 6 7 10 11 12 14 17 18 19 20 21 24 25 26 27 28 1 2 3 4 5 8 9 10 11 12 15
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
37
38
39
40
Vidal, Angelica
Cabalar, Carlos Jonel V.
Tamayo, Marlon D.
Aquino, Benjie V.
TOTAL
D. Actual Feeding
( ) - Present, served
( A ) - Absent, not served
( ) - Present, served twice
page 2
SBFP Form 4
SCHOOL-BASED FEEDING PROGRAM
ACTUAL FEEDING
NAME OF PUPIL
58
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
26
27
28
29
30
31
32
33
34
35
36
59
60
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
Arenas, Jeayea P.
Sembrana, Honey Khae
Paras, Noah
Reyes, Dexter
Bernardez Jr. Eduardo M.
De Guzman, Melvin P.
Doloque, John Patrick
Calleja, San Joe E.
Panganiban, Alexander James S.
De Guzman, Mark V.
Vidal, Anthonette Gel DC.
Veloso, Gizl P.
Calupit, Ashley
Abule, Rhencel L.
Capinpin, Princess Mae P.
Narag, Jasmin
Munar, Shanelle Irish C.
Maragana, Angelo E.
Dela Cruz, Jessalyn Joy L.
Yao, Jerome V.
Mercado, Edra Jane
Samson, Juvelyn S.
Aquino, Marcilo S.
Vidal, Elizabeth F.
Arguelles, John Wayne C.
Reyes, Kassandra Kyle
Ampalayan, Aldrin M.
Toralba, Jesus Gabrielle C.
Paras, Clarissa S.
Carrera, Cindy
Corbillon, Christian F.
Lazo, Ruwei J.
Veloso, Remedios P.
Gutierrez, Wilfred S.
Garcia, Paula V.
Labrador, Normie Lea P.
page 3
SBFP Form 4
SCHOOL-BASED FEEDING PROGRAM
ACTUAL FEEDING
NAME OF PUPIL
58
37
38
39
40
59
60
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
Vidal, Angelica
Cabalar, Carlos Jonel V.
Tamayo, Marlon D.
Aquino, Benjie V.
TOTAL:
D. Actual Feeding
( ) - Present, served
( A ) - Absent, not served
( ) - Present, served twice
page 3
SBFP Form 4
SCHOOL-BASED FEEDING PROGRAM
School: _____________________________________
Grade: __________ Section _____________________
ACTUAL FEEDING
POST FEEDING
NAME OF PUPIL
98
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
26
27
28
29
30
31
32
33
34
99
100
101
102
103
104
105
106
107
108
109
110
111
112
113
114
115
116
117
118
119
120
Ht
cm
Nutritional Status
Wt
Date
kg
Taken
ATTENDANCE
NS
Days
Present
Feeding
Days
(A)
(B)
Arenas, Jeayea P.
Sembrana, Honey Khae
Paras, Noah
Reyes, Dexter
Bernardez Jr. Eduardo M.
De Guzman, Melvin P.
Doloque, John Patrick
Calleja, San Joe E.
Panganiban, Alexander James S.
De Guzman, Mark V.
Vidal, Anthonette Gel DC.
Veloso, Gizl P.
Calupit, Ashley
Abule, Rhencel L.
Capinpin, Princess Mae P.
Narag, Jasmin
Munar, Shanelle Irish C.
Maragana, Angelo E.
Dela Cruz, Jessalyn Joy L.
Yao, Jerome V.
Mercado, Edra Jane
Samson, Juvelyn S.
Aquino, Marcilo S.
Vidal, Elizabeth F.
Arguelles, John Wayne C.
Reyes, Kassandra Kyle
Ampalayan, Aldrin M.
Toralba, Jesus Gabrielle C.
Paras, Clarissa S.
Carrera, Cindy
Corbillon, Christian F.
Lazo, Ruwei J.
Veloso, Remedios P.
Gutierrez, Wilfred S.
page 4
SBFP Form 4
SCHOOL-BASED FEEDING PROGRAM
School: _____________________________________
Grade: __________ Section _____________________
ACTUAL FEEDING
POST FEEDING
NAME OF PUPIL
98
35
36
37
38
39
40
99
100
101
102
103
104
105
106
107
108
109
110
111
112
113
114
115
116
117
118
119
120
Ht
cm
Nutritional Status
Wt
Date
kg
Taken
ATTENDANCE
NS
Days
Present
Feeding
Days
(A)
(B)
Garcia, Paula V.
Labrador, Normie Lea P.
Vidal, Angelica
Cabalar, Carlos Jonel V.
Tamayo, Marlon D.
Aquino, Benjie V.
TOTAL:
AVERAGE:
D. Actual Feeding
( ) - Present, served
( A ) - Absent, not served
( ) - Present, served twice
page 4
NDANCE
Percentage
(A/B)*100
page 4
NDANCE
Percentage
(A/B)*100
page 4
SBFP Form 5
SCHOOL-BASED FEEDING PROGRAM
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
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