Department of Education
Region IVA
Participation
Date of Weighing / Age in Weight Height BMI for 6 y.o. Nutritional in 4Ps
Date of Birth
No. Name Sex Measuring Years / Name of Parents
(MM/DD/YYYY)
(MM/DD/YYYY) Months (Kg) (cm) and above Status (NS) (yes or
no)
1 Cordero, Ashley Nicole Ticman F 1/6/2008 6/8/2018 10.5 21.4 1.3 12.6 WASTED CORDERO, ERNESTO ELISTERIO JR
2 Eser, Elijun M 23-Aug-08 9.9 25.7 1.39 13.30 WASTED ESER,ROSELLE,APILADA,
3 Galaboc, Lauren Vince M 22-Sep-07 10.8 30.6 1.51 13.40 WASTED GALABOC, LAURENCE FADUL
4 Vargas, Cristian Jheff M 6-Jul-08 9.11 26 1.4 13.20 WASTED VARGAS, JEFFREY QUIRIMIT
5 Cueto, Prenciss Gean Kim F 21-Apr-08 10.1 20.6 1.39 10.70 SEVERLY WASTED CUETO, CANDIDO ANDAL
6 Niangar, Marimar F 12-Nov-07 10.6 18.3 1.22 12.20 SEVERLY WASTED NIANGAR, MARIO VILLAPANDO
7 Torio, Tristen F 23-Dec-07 10.5 25.7 1.40 13.10 WASTED TORIO, DARRYLL ANTHONY LIPIO
Bagorio, Bezabel Sabela M 3-Feb-08 10.4 23.8 1.323 13.50 WASTED
Gaviola, Ryan Eduardo M 30-Jan-08 10.4 21.2 1.286 12.8 SEVERLY WASTED
Macaspac, Knives Justine Bartolo M 1-Apr-08 10.2 21.9 1.355 11.90 SEVERLY WASTED
Matandac, John Melton Balay M 3-Jan-08 10.5 23.2 1.32 13.30 WASTED
Mulingbayan, Jared Caseria M 22-Jun-08 9.11 22.8 1.32 13.00 WASTED
Cruz, Jamaica Rhey Anne R. F 11/12/2007 10.6 21.2 1.278 12.90 WASTED
Florentino, Anika Isshe Dayrit F 1/18/2008 10.4 33.4 1.569 13.50 WASTED
Mulingbayan, Rhian Buela F 7/2/2008 9.11 23.1 1.35 12.60 WASTED
Prepared by:
__________________________________
School 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 DepEd-HNC
Beneficiary of SBFP
in Previous Years
(yes or no)
SBFP Form 1
Department of Education
Region IVA
Participation
Date of Weighing / Age in Weight Height BMI for 6 y.o. Nutritional in 4Ps
Date of Birth
No. Name Sex Measuring Years / Name of Parents
(MM/DD/YYYY)
(MM/DD/YYYY) Months (Kg) (cm) and above Status (NS) (yes or
no)
1 Sojon, Margie Divino F 5/23/2008 7/8/2018 10 22.9 1.371 12.10 SEVERLY WASTED
2 Acoymo, Ej Macareal M 7/4/2007 10.11 21 1.24 13.90 WASTED ACOYMO, NESTOR DIONSAY
3 Ando, Lui John Samson M 7/13/2006 11.1 25 1.33 14.20 WASTED ANDO, LIXIE
4 Aquino, Mark Daniel Ruben M 1/24/2008 12.50 23 1.36 12.50 SEVERLY WASTED RUBEN,MARINEL,,
5 Ballester, Hanz Lester Cinense M 7/23/2008 9.1 25 1.69 8.70 SEVERLY WASTED BALLESTER, HENRY ASTIBE
6 Coranes, Mark Jayloe Abao M 9/16/2007 10.8 18 1.14 13.40 WASTED CORANES, GARY GERELLA
7 Velasco, Edman Fernandez M 7/3/2000 17.11 38 1.52 16.50 WASTED VELASCO, EDUARDO C
Alejandro, Jennylyn Obregon F 9/28/2008 9.8 26 1.39 13.10 WASTED OBREGON,BABYLIN,ANGANA,
Badang, Angelica Brenio F 11/10/2007 10.6 30 1.8 9.20 SEVERLY WASTED BADANG, FREDDIE LEDESMA
Calacal, Diana F 8/20/2008 9.9. 24 1.36 12.90 WASTED CALACAL, DONNIE RAY LEANDADO
Delicano, Kyle Mariz Espinosa F 8/28/2008 9.9. 24 1.4 12.30 WASTED DELICANO, RENE CATINDOY
Gain, Flor Paulene Bernabe F 11/25/2007 10.6 24 1.35 13.10 WASTED GAIN, HIPOLITO
Jose, Joana Marie Briones F 5/16/2008 10 21 1.26 12.90 WASTED JOSE, RIZAL AFRICA
Manaligod, Cristal Flores F 8/25/2008 9.9 20 1.37 10.60 SEVERLY WASTED FLORES,LORELIE,ESPIRITU,
Padilla, Dyesebel Guinto F 8/16/2008 9.9 19 1.24 12.40 WASTED PADILLA, DENNIS PASETES
Prepared by:
__________________________________
School 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 DepEd-HNC
Beneficiary of SBFP
in Previous Years
(yes or no)
SBFP Form 1
Department of Education
Region IVA
Participation
Date of Weighing / Age in Weight Height BMI for 6 y.o. Nutritional in 4Ps
Date of Birth
No. Name Sex Measuring Years / Name of Parents
(MM/DD/YYYY)
(MM/DD/YYYY) Months (Kg) (cm) and above Status (NS) (yes or
no)
1 Tabudlong, Nina Canoza F 9/25/2008 7/8/2018 9.8 22 1.28 13.10 WASTED TABUDLONG, ARNOLD MASCARINAS
2
3
4
5
6
7
Prepared by:
__________________________________
School 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 DepEd-HNC
Beneficiary of SBFP
in Previous Years
(yes or no)
SBFP Form 2
Department of Education
Region IV A
Division/Province: RIZAL
School District/City/ Municipality : ANGONO
1. Kinder
33 47 80 27 0
2. Grade I
50 24 74 27 22
3. Grade II
27 35 62 22 21
4. Grade III
17 52 69 21 23
5. Grade IV
38 38 76 26 28
6. Grade V
16 31 47 18 19
7. Grade VI
21 39 60 21 26
Prepared by:
Noted by:
______________________________________ __________________________________
SBFP School Focal Person School Head
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 DepEd-HNC
SBFP Form 4
SCHOOL-BASED FEEDING PROGRAM
RECORD OF DAILY FEEDING
ACTUAL FEEDING
PRE FEEDING
4Ps
NAME OF PUPIL Beneficiary Beneficiary Nutritional Status Deworming
(y or n) of Previous Ht Wt Date
SBFP
Age Birth Sex (√ ) or Date
NS
(y or n) 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
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
____________________________ A. Nutritional Status
B. Deworming D. Actual Feeding
Feeding Teacher / School Nurse 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
Page 13
Note: This form shall be prepared by the school to be consolidated using SBFP Form 5
Page 14
SBFP Form 4
ACTUAL FEEDING
NAME OF PUPIL
21 22 ### 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
ACTUAL FEEDING
NAME OF PUPIL
61 62 ### 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
D. Actual Feeding
( √ ) - Present, served
( A ) - Absent, not served
(√√ ) - Present, served twice
page 4
page 4
SBFP Form 6-A
Annex 8
SCHOOL-BASED FEEDING CONSOLIDATED PROGRAM TERMINAL REPORT - PROGRAM ACCOMPLISHMENT
SY ___________________
Region: IV A
Division: RIZAL
District: __________
SBFP
GPP
Beneficiaries Financial Status (School)
Status of
implementation Total No. of
Previous Amount
(completed,
Name of School Regional Dewormed 4Ps Beneficiaries Beneficiaries of Feeding Sustained/Y Vegetables \ Remarks
School ID SBFP
discontinue, for
Modality Amount Downloa Disburse Liquidate
Beneficia Actual % continuation, or ear Round used for
Allocated ded/Rece d d
ries number of feeding Garden Feeding (in
days completed) ived
No. % No. % No. % Kilos)
JGES 109313 468 100 468 100 162 34.62 139 29.70
TOTAL
Note:
This form shall be prepared by the schools
SBFP Form 6-B
Region: IV A
Division: RIZAL
District: __________
SBFP
Beneficiaries Financial Status (SDO) GPP
No .of Status of
DepEd- No. of SBFP Schools No. of Beneficiaries
No. of Schools implementation
with SHD (completed,
SDO Total No. of
Division Feeding Allocation Previous discontinue, for Amount Sustained/ Remarks
School (Partner, per Regional Dewormed 4Ps Beneficiaries Beneficiaries of continuation, or Vegetables \
s Funded, SBFP number of feeding Amount Downloa Disburse Liquidate Year
RO/SDO Beneficia Actual % Regional Actual % used for
Others) days completed) Allocated ded/Rece d d Round
ries Feeding (in
ived Garden
No. % No. % No. % Kilos)
TOTAL
SBFP Form 6-C
Region: IV A
Division: RIZAL
District: ANGONO
TOTAL 468 202 266 0 0 0 468 129 187 152 0 0 468 35 108 325 0 0 468
Note:
This form shall be prepared by the schools
SBFP Form 6-D
Region: IV A
Division: RIZAL
District: __________
TOTAL
Note:
This form shall be prepared by the schools
SBFP Form 6-E
Region: IV A
Division: RIZAL
District: __________
% Attendance
Division/Schools Average of
Month 0 Month 1 Month 2 Month 3 Month 4 Month 5 Month 6 Month 7
Months 1-7
Note:
This form shall be prepared by the schools
SBFP Form 6-F
Region: IV A
Division: RIZAL
District: __________
(/) or (X) (/) or (X) (/) or (X) (/) or (X) (/) or (X) (/) or (X) (/) or (X) (/) or (X)
Note:
This form shall be prepared by the schools
SBFP Form 6-G
Region:IV A
Division: RIZAL
District: __________
INSTRUCTIONS : Check the school's adherence to the School Feeding standards based on the
absence or presence of the key requirements. Additional comments can be written in the remarks
column.
Accomplished by :
Conformed by :
Date: _______________________
School: _______________________________
3. Orientation of SBFP
• With Orientation
• Without Orientation
5. Program Management
• Date Started
• Expected Number of Days of Completion
• Procurement Method Followed
• Nutrition Education During Feeding
• Weighing Scale Used in School
• Compliance to Cycle Menu
• Attendance of the Beneficiaries
• Parents Involvement
6. Development of Health and Nutritional Values
• Proper Handwashing
• Prayer Before and After Meal
• Good Grooming and Personal Hygiene
7. Complementary Activities
• Number of Beneficiaries Dewormed
• With Functional School Garden
• Waste Segregation and Composting
• Adherence to Food Safety