SBFP Form 4

SCHOOL-BASED FEEDING PROGRAM

FOR THE MONTH OF MARCH , SY 2018

Region IV-A CALABARZON
Division TANAUAN CITY
District TANAUAN CITY WEST

4Ps
PRE FEEDING
Beneficiar
NAME OF PUPIL Beneficiar y of Nutritional Status Deworming
y (y or n) Previous
Age Sex Ht Wt Date (√ ) or Date
SBFP NS
(y or n) Birth Date cm kg Taken (X) Taken

1 ARCEBUCHE,NAMERAD JOSH U. N 61 M 5/18/2012 M 1.04 13 6/23/2017 W / 7/10/2017

2 MABUYO,XIAN JAMES L. N 65M 12/27/2011 M 1.1 18 6/23/2017 W / 7/10/2017
3 SORIMA,JUSTIN A. N 62M 4/11/2012 M 1.07 13 6/23/2017 W / 7/10/2017
4 AUSTRIA,JHANDYL R. Y 6,0 6/22/2011 M 1.13 16 6/23/2017 W / 7/10/2017
5 LAURINARIA, RED A. Y 6,4 2/23/2011 M 1.09 15 6/23/2017 W / 7/10/2017
6 MANAIG,VIEN JARED D. Y 6,11 7/5/2010 M 1.11 16 6/23/2017 W / 7/10/2017
7 NATIVIDAD,KIAN ROVIC C. N 6,5 1/21/2011 M 1.15 17 6/23/2017 W / 7/10/2017
8 MAGNAYE,AIZEL JOY U. Y 6,6 12/9/2010 F 1 12 6/23/2017 W / 7/10/2017
9 TERRIBLE,AINGEL A. N 6,9 8/24/2011 F 1.11 14 6/23/2017 W / 7/10/2017
10 ACLAG,LANCE JERICK B. N 7,5 1/15/2010 M 1.2 19 6/23/2017 W / 7/10/2017
11 DE LOVINO, JOHN RHEIN U. N 7,3 3/12/2010 M 1.14 17 6/23/2017 W / 7/10/2017
12 MARIANO JR., LEO R. N 6,11 6/30/2010 M 1.02 13 6/23/2017 W / 7/10/2017
13 TERRIBLE,NEIL C. N 7,6 12/21/2009 M 1.17 18 6/23/2017 W / 7/10/2017
14 GARCIA,ALREAN U. N 6,10 8/18/2010 F 1.1 15 6/23/2017 W / 7/10/2017
15 VERINA,JAYBHE R. N 8,7 11/22/2008 M 1.2 19 6/23/2017 W / 7/10/2017
16 ARQUINOSO,ARIANNE C. Y 8,2 3/27/2009 F 1.2 18 6/23/2017 W / 7/10/2017
17 MAGNAYE,LYNLYN U. N 8,0 6/12/2009 F 1.1 15 6/23/2017 W / 7/10/2017
18 ACLAG,BYANCE STANLEY B. N 9,5 1/2/2007 M 1.31 22 6/23/2017 W / 7/10/2017
19 SANTOS,ANGELO JAMES M. N 9,1 4/30/2008 M 1.28 22 6/23/2017 W / 7/10/2017
20 REBUCAN,SOFIAH A. N 8,10 8/21/2008 F 1.27 21 6/23/2017 W / 7/10/2017
21 DE PAZ,PAUL ZEDRICK Y 9,7 10/24/2007 M 1.24 20 6/23/2017 W / 7/10/2017
22 TERRIBLE,IVAN GERVY E. Y 10,4 1/24/2007 M 1.29 24 6/23/2017 W / 7/10/2017
23 ALMENDRAS,ANGELA A. N 10,2 4/20/2007 F 1.25 21 6/23/2017 W / 7/10/2017
24 AUSTRIA,KERTH DERWIN M. Y 11,1 5/22/2006 M 1.3 23 6/23/2017 W / 7/10/2017
25 MARIANO,LEI ANDREI R. Y 11,2 4/22/2006 M 1.25 22 6/23/2017 W / 7/10/2017
26 REBUCAN,JOHN RUSSEL A. Y 10,9 9/16/2006 M 1.3 22 6/23/2017 W / 7/10/2017
TOTAL:
Prepared by:
LEGEND
LORNA C. NATANAUAN A. Nutritional Status
Feeding Teacher / School Nurse 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 - Overwieght Ow - Overwieght
O - Obese

Note: This form shall be prepared by the school to be consolidated using SBFP Form 5
 SBFP Form 4
SCHOOL-BASED FEEDING PROGRAM
FOR THE MONTH OF DECEMBER, SY 2019
Region IV-A CALABARZON
Division TANAUAN CITY
District TANAUAN CITY WEST
Beneficiar PRE FEEDING
4Ps y of Nutritional Status Deworming
NAME OF PUPIL Beneficiar Previous
y (y or n) SBFP Age Sex Ht Wt Date (√ ) or Date
NS
(y or n) Birth Date cm kg Taken (X) Taken
1 Aclag, Jeff Laurence B. Y 6,7 4/17/2013 M 1.16 1.16 06/14/2019 SW / 3/7/2019
2 Garcia Andrei C. N 6,1 5/13/2013 M 1.17 17 06/14/2019 W / 3/7/2019
3 Laurenaria, Rain A. N 69M 8/26/2013 M 1.07 13 06/14/2019 SW / 3/7/2019
4 Moreno, Joshua B. N 68M 9/27/2013 F 1.1 15 06/14/2019 W / 3/7/2019
5 Garcia, Alvien U. Y 6,4 1/25/2013 F 1.11 13 06/14/2019 SW / 3/7/2019
6 Geronimo, Aliyah Briel M. N 71M 6/27/2013 F 1.1 15 06/14/2019 W / 3/7/2019
7 Gonzales, Rhian Alexis L. Y 65M 12/15/2013 F 1.2 12 06/14/2019 SW / 3/7/2019
8 Liangco, Stephanne Anne P. N 69M 9/7/2013 F 1.23 13 06/14/2019 SW / 3/7/2019
9 Padilla, Kylie Miel S. N 6,4 2/7/2013 F 1.18 17 06/14/2019 W / 3/7/2019
10 Terrible, Airene A. N 69M 8/27/2013 M 1.06 13 06/14/2019 SW / 3/7/2019
11 Arcebuche, Namerad Josh U. Y 7 5/18/2019 M 1.04 12.2 06/14/2019 SW / 3/7/2019
12 Mabuyo, Xian James L. Y 7,8 5/31/2012 M 11.05 12.8 06/14/2019 SW / 3/7/2019
13 Magnaye, Hyzron M. Y 7,0 7/10/2012 M 1.09 14.4 06/14/2019 SW / 3/7/2019
14 Malabanan, Melvin M. Y 6,10 7/24/2012 F 1.04 12.6 06/14/2019 SW / 3/7/2019
15 Mendoza, Justin M. N 7,4 1/19/2012 M 1.11 16 06/14/2019 W / 3/7/2019
16 Sorima, Justin M. Y 7,2 11/4/2012 M 1.08 15 06/14/2019 W / 3/7/2019
17 Lane, Kimberly M. Y 6,11 6/22/2012 F 1.05 14 06/14/2019 W / 3/7/2019
18 Moreno, Angel Coleen A. Y 7,5 1/1/2012 F 1.15 16.5 06/14/2019 W / 3/7/2019
19 Austria, Jhandyl R. N 9,1 6/22/2011 M 1.15 17 06/14/2019 W / 3/7/2019
20 Laurenaria, Red A. Y 8,10 2/23/2011 M 1.13 11.5 06/14/2019 SW / 3/7/2019
21 Manaig, Vien jared D. Y 9,7 7/5/2010 M 1.15 16 06/14/2019 SW / 3/7/2019
22 Pacurib, Jandee D. N 10,4 3/27/2011 F 1.19 16 06/14/2019 SW / 3/7/2019
23 Magnaye, Aizel Joy U. Y 10,2 12/9/2011 F 1.06 14 06/14/2019 W / 3/7/2019
24 De Lovino, John Rein U. Y 11,1 3/12/2010 M 1.2 18 06/14/2019 SW / 3/7/2019
25 Mariano, Leo Jr. R. Y 11,2 6/30/2010 M 1.14 16 06/14/2019 SW / 3/7/2019
26 Pacurib, Nashly D. N 10,9 5/28/2010 M 1.22 20 06/14/2019 W / 3/7/2019
27 Carolino, Tricia Mae D. Y 9,1 1/12/2010 F 1.25 16.9 06/14/2019 SW / 3/7/2019
28 Garcia, Alrean U. Y 8,10 8/18/2010 F 1.21 18 06/14/2019 W / 3/7/2019
29 Carvajal, Aaron Joshua A. Y 9,7 1/25/2009 M 1.35 23.4 06/14/2019 W / 3/7/2019
30 De Paz, Cyrus M. Y 10,4 2/24/2009 M 1.39 25 06/14/2019 W / 3/7/2019
31 Sorima, John Ryan A. Y 10,2 1/7/2009 M 1.26 21 06/14/2019 W / 3/7/2019
32 Virena, Jaybhe R. Y 11,1 11/22/2009 M 1.3 23 06/14/2019 W / 3/7/2019
33 Arquinoso, Ariane C. Y 11,2 03/27/2009 F 1 24 06/14/2019 W / 3/7/2019
34 Manaig, Angel Ayesha D. Y 10,9 01/19/2009 F 1.3 21.7 06/14/2019 W / 3/7/2019
35 Mendoza, Angel A. Y 10,2 10/13/2009 F 1.31 22.1 06/14/2019 W / 3/7/2019
36 Aclag, Byance Stanley B. Y 11,1 1/21/2008 M 1.42 27 06/14/2019 W / 3/7/2019
37 Mendoza, Adrian D. Y 11,2 11/18/2007 M 1.4 25 06/14/2019 W / 3/7/2019
38 Santos, Angelo James M. Y 10,9 4/30/2008N - Normal1.4 27 06/14/2019 W / 3/7/2019
TOTAL:
Prepared by:
LEGEND
MANNIELLE MAE T. OLIVA A. Nutritional Status
Feeding Teacher / School Nurse 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 - Overwieght Ow - Overwieght
O - Obese

Note: This form shall be prepared by the school to be consolidated using SBFP Form 5
 ACTUAL FEEDING

5 6 7 8 12 15 13 14 15 16 19

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GEND
B. Deworming

( x ) - not dewormed
( √ ) - dewormed
 ACTUAL FEEDING

108 109 110 111 112 113 114 115 116 117 118 119 120
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GEND
B. Deworming

( x ) - not dewormed
( √ ) - dewormed
 ACTUAL FEEDING

104 105 106 107 106 4 5 6 7 8 9 10 11 12 13

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AL FEEDING

14 15 16 17 18 19 20 21
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SBFP Form 1
Department of Education
Region 1V-A

Master List Beneficiaries for School-Based Feeding Program (SBFP)

Division TANAUAN CITY Name of Principal : SILVINA M. MENDOZA

City/ Municipality/Barangay : _____ SAN JOSE TANAUAN CITY Name of Feeding Focal Person : MARINA P. TERRIBLE
Name of S AN JOSE ELEMENTARY
BMI for Beneficiary of SBFP
Date of Weighing / Age in Weight Height 6 y.o. Nutritional 4Ps ID
Date of Birth
No. Name Sex Measuring Years / (Kg) and Status (NS) Ethnicity Disability Name of Parents in Previous Years
(MM/DD/YYYY) (cm) Number
1 Aclag, Byance Stanley B. M 1/2/2008 (MM/DD/YYYY)
6/11/2014 Months 6.5 16 1.17 11.60 Severely Wasted
above Jeffrey (yesNo
or no)
2 Arcebuche, Elaiza U. F 11/3/2007 6/11/2014 6.7 15 1.17 10.90 Severely Wasted Namerad No
3 Garcia, Aljean U. F 1/26/2008 6/11/2014 6.4 15 1.16 11.10 Severely Wasted Jason No
4 Rebucan, Sofiah A. F 8/21/2008 6/11/2014 6.9 13 1.07 Severely Wasted Guillermo Yes
5 Nuqui, Jesther A. M 12/18/2001 6/11/2014 11.5 25 1.36 14.10 Severely Wasted Dexter No
6 Magnaye, Rolando Jr. T M 8/25/2008 6/11/2014 6.9 14 1.08 Wasted Rolando No
7 Marqueses, Denmark D. M 3/1/2008 6/11/2014 6.3 17 1.17 12.40 Wasted William Yes
8 Mendoza, Adrian D. M 11/18/2007 6/11/2014 6.6 16 1.12 12.70 Wasted Erwin No
9 Santos, Angelo James M. M 4/30/2008 6/11/2014 6.1 16 1.12 12.70 Wasted Melbert Yes
10 Magnaye, Stephanne P. F 12/20/2007 6/11/2014 6.5 17 1.18 12.20 Wasted Sonny No
11 Umandap, Jayvee T. M 6/29/2007 6/11/2014 6.11 20 1.25 12.80 Wasted Eufemio Yes
12 Carolino, Arlene D. F 6/6/2007 6/11/2014 6.11 18 1.11 14.60 Wasted Arnel No
13 Carolino, John Rainier D. M 10/31/2006 6/11/2014 7.7 18 1.19 12.70 Wasted Nicanor No
14 Landicho, John Paulo G. M 9/24/2006 6/11/2014 7.8 19 1.22 12.70 Wasted Binilo Yes
15 Mariano, Lei Andrie R. M 4/22/2006 6/11/2014 8.1 16 1.1 13.20 Wasted Leo Yes
16 Virena, Jhenny R. F 10/28/2005 6/11/2014 8.7 19 1.23 12.50 Wasted Antonia Yes
17 Duran, Dan Rhojomie A. M 11/26/2003 6/11/2014 23 1.33 13.00 Wasted Eliazar No
18 Matanguihan, Eliel Jay M. M 5/29/2003 6/11/2014 11 28 1.42 13.8 Wasted Elmer No
19 Mercado, Raven R. M 9/9/2003 6/11/2014 10.9 26 1.37 13.8 Wasted Rafael Yes
20 Gerosa, Wesly Joy L F 5/28/2003 6/11/2014 11 28 1.42 13.8 Wasted Josephine No
21 Rebucan, Joyce F 11/10/2002 6/11/2014 11.7 23 1.32 13.2 Wasted Antonia Yes
22 Terrible, Kyla A. F 3/11/2003 6/11/2014 11.3 28 1.42 13.8 Wasted Oliver Yes

Prepared by: Noted :

________MARINA P. TERRIBLE SILVINA M. MENDOZA

Feeding Focal Person School Principal / Officer-in-Charge

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 MONTH OF MARCH , SY 2018

Region IV-A CALABARZON
Division TANAUAN CITY
District TANAUAN CITY WEST

ACTUAL
PRE FEEDING FEEDING
4Ps Beneficiar
NAME OF PUPIL Beneficiar y of Nutritional Status Deworming
y (y or n) Previous
Age Sex Ht Wt Date (√ ) or Date
SBFP NS
(y or n) Birth Date cm kg Taken (X) Taken 5 6 7 8 12 15 13 14 15 16 19

1 ARCEBUCHE,NAMERAD JOSH U. N 61 M 5/18/2012 M 1.04 13 6/23/2017 W / 7/10/2017 / / / / / / / / / / /

2 MABUYO,XIAN JAMES L. N 65M 12/27/2011 M 1.1 18 6/23/2017 W / 7/10/2017 / / / / / / / / / / /
3 SORIMA,JUSTIN A. N 62M 4/11/2012 M 1.07 13 6/23/2017 W / 7/10/2017 / / / / / / / / / /
4 AUSTRIA,JHANDYL R. Y 6,0 6/22/2011 M 1.13 16 6/23/2017 W / 7/10/2017 / / / / / / / / / /
5 LAURINARIA, RED A. Y 6,4 2/23/2011 M 1.09 15 6/23/2017 W / 7/10/2017 / / / / / / / / / /
6 MANAIG,VIEN JARED D. Y 6,11 7/5/2010 M 1.11 16 6/23/2017 W / 7/10/2017 / / / / / / / / / /
7 NATIVIDAD,KIAN ROVIC C. N 6,5 1/21/2011 M 1.15 17 6/23/2017 W / 7/10/2017 / / / / / / / / / /
8 MAGNAYE,AIZEL JOY U. Y 6,6 12/9/2010 F 1 12 6/23/2017 W / 7/10/2017 / / / / / / / / / /
9 TERRIBLE,AINGEL A. N 6,9 8/24/2011 F 1.11 14 6/23/2017 W / 7/10/2017 / / / / / / / / / /
10 ACLAG,LANCE JERICK B. N 7,5 1/15/2010 M 1.2 19 6/23/2017 W / 7/10/2017 / / / / / / / / / /
11 DE LOVINO, JOHN RHEIN U. N 7,3 3/12/2010 M 1.14 17 6/23/2017 W / 7/10/2017 / / / / / / / / / /
12 MARIANO JR., LEO R. N 6,11 6/30/2010 M 1.02 13 6/23/2017 W / 7/10/2017 / / / / / / / / / /
13 TERRIBLE,NEIL C. N 7,6 12/21/2009 M 1.17 18 6/23/2017 W / 7/10/2017 / / / / / / / / / /
14 GARCIA,ALREAN U. N 6,10 8/18/2010 F 1.1 15 6/23/2017 W / 7/10/2017 / / / / / / / / / /
15 VERINA,JAYBHE R. N 8,7 11/22/2008 M 1.2 19 6/23/2017 W / 7/10/2017 / / / / / / / / / /
16 ARQUINOSO,ARIANNE C. Y 8,2 3/27/2009 F 1.2 18 6/23/2017 W / 7/10/2017 / / / / / / / / / /
17 MAGNAYE,LYNLYN U. N 8,0 6/12/2009 F 1.1 15 6/23/2017 W / 7/10/2017 / / / / / / / / / /
18 ACLAG,BYANCE STANLEY B. N 9,5 1/2/2007 M 1.31 22 6/23/2017 W / 7/10/2017 / / / / / / / / / /
19 SANTOS,ANGELO JAMES M. N 9,1 4/30/2008 M 1.28 22 6/23/2017 W / 7/10/2017 / / / / / / / / / /
20 REBUCAN,SOFIAH A. N 8,10 8/21/2008 F 1.27 21 6/23/2017 W / 7/10/2017 / / / / / / / / / /
21 DE PAZ,PAUL ZEDRICK Y 9,7 10/24/2007 M 1.24 20 6/23/2017 W / 7/10/2017 / / / / / / / / / /
22 TERRIBLE,IVAN GERVY E. Y 10,4 1/24/2007 M 1.29 24 6/23/2017 W / 7/10/2017 / / / / / / / / / /
23 ALMENDRAS,ANGELA A. N 10,2 4/20/2007 F 1.25 21 6/23/2017 W / 7/10/2017 / / / / / / / / / /
24 AUSTRIA,KERTH DERWIN M. Y 11,1 5/22/2006 M 1.3 23 6/23/2017 W / 7/10/2017 / / / / / / / / / /
25 MARIANO,LEI ANDREI R. Y 11,2 4/22/2006 M 1.25 22 6/23/2017 W / 7/10/2017 / / / / / / / / / /
26 REBUCAN,JOHN RUSSEL A. Y 10,9 9/16/2006 M 1.3 22 6/23/2017 W / 7/10/2017 / / / / / / / / / /
TOTAL:
Prepared by:
LEGEND
LORNA C. NATANAUAN A. Nutritional Status
B. Deworming
Feeding Teacher / School Nurse For 6-19 y.o For below 6 y.o
SW - Severely wasted SU - Severely underweight ( x ) - not dewormed
 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
 SBFP Form 4
SCHOOL-BASED FEEDING PROGRAM
FOR THE MONTH OF JULY , SY 2019
Region IV-A CALABARZON
Division TANAUAN CITY
District TANAUAN CITY WEST
Beneficiar PRE FEEDING ACTUAL FEEDING
4Ps y of Nutritional Status Deworming
NAME OF PUPIL Beneficiar Previous
y (y or n) SBFP Age Sex Ht Wt Date (√ ) or Date
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
1 Aclag, Jeff Laurence B. Y 6,7 4/17/2013 M 1.16 1.16 06/14/2019 SW / 3/7/2019 / / / / / / / / / / / /
2 Garcia Andrei C. N 6,1 5/13/2013 M 1.17 17 06/14/2019 W / 3/7/2019 / / / / / / / / / / / /
3 Laurenaria, Rain A. N 69M 8/26/2013 M 1.07 13 06/14/2019 SW / 3/7/2019 / / / / / / / / / / / /
4 Moreno, Joshua B. N 68M 9/27/2013 F 1.1 15 06/14/2019 W / 3/7/2019 / / / / / / / / / / / /
5 Garcia, Alvien U. Y 6,4 1/25/2013 F 1.11 13 06/14/2019 SW / 3/7/2019 / / / / / / / / / / / /
6 Geronimo, Aliyah Briel M. N 71M 6/27/2013 F 1.1 15 06/14/2019 W / 3/7/2019 / / / / / / / / / / / /
7 Gonzales, Rhian Alexis L. Y 65M 12/15/2013 F 1.2 12 06/14/2019 SW / 3/7/2019 / / / / / / / / / / / /
8 Liangco, Stephanne Anne P. N 69M 9/7/2013 F 1.23 13 06/14/2019 SW / 3/7/2019 / / / / / / / / / / / /
9 Padilla, Kylie Miel S. N 6,4 2/7/2013 F 1.18 17 06/14/2019 W / 3/7/2019 / / / / / / / / / / / /
10 Terrible, Airene A. N 69M 8/27/2013 M 1.06 13 06/14/2019 SW / 3/7/2019 / / / / / / / N / / / / /
11 Arcebuche, Namerad Josh U. Y 7 5/18/2019 M 1.04 12.2 06/14/2019 SW / 3/7/2019 / / / / / / / O / / / / /
12 Mabuyo, Xian James L. Y 7,8 5/31/2012 M 11.05 12.8 06/14/2019 SW / 3/7/2019 / / / / / / / C / / / / /
13 Magnaye, Hyzron M. Y 7,0 7/10/2012 M 1.09 14.4 06/14/2019 SW / 3/7/2019 / / / / / / / L / / / / /
A
14 Malabanan, Melvin M. Y 6,10 7/24/2012 F 1.04 12.6 06/14/2019 SW / 3/7/2019 / / / / / / / S / / / / /
15 Mendoza, Justin M. N 7,4 1/19/2012 M 1.11 16 06/14/2019 W / 3/7/2019 / / / / / / / S / / / / /
E
16 Sorima, Justin M. Y 7,2 11/4/2012 M 1.08 15 06/14/2019 W / 3/7/2019 / / / / / / / S / / / / /
17 Lane, Kimberly M. Y 6,11 6/22/2012 F 1.05 14 06/14/2019 W / 3/7/2019 / / / / / / / / / / / /
D
18 Moreno, Angel Coleen A. Y 7,5 1/1/2012 F 1.15 16.5 06/14/2019 W / 3/7/2019 / / / / / / / U / / / / /
19 Austria, Jhandyl R. N 9,1 6/22/2011 M 1.15 17 06/14/2019 W / 3/7/2019 / / / / / / / E / / / / /
20 Laurenaria, Red A. Y 8,10 2/23/2011 M 1.13 11.5 06/14/2019 SW / 3/7/2019 / / / / / / / T / / / / /
21 Manaig, Vien jared D. Y 9,7 7/5/2010 M 1.15 16 06/14/2019 SW / 3/7/2019 / / / / / / / O / / / / /
22 Pacurib, Jandee D. N 10,4 3/27/2011 F 1.19 16 06/14/2019 SW / 3/7/2019 / / / / / / / B / / / / /
23 Magnaye, Aizel Joy U. Y 10,2 12/9/2011 F 1.06 14 06/14/2019 W / 3/7/2019 / / / / / / / A / / / / /
D
24 De Lovino, John Rein U. Y 11,1 3/12/2010 M 1.2 18 06/14/2019 SW / 3/7/2019 / / / / / / / / / / / /
25 Mariano, Leo Jr. R. Y 11,2 6/30/2010 M 1.14 16 06/14/2019 SW / 3/7/2019 / / / / / / / W / / / / /
E
26 Pacurib, Nashly D. N 10,9 5/28/2010 M 1.22 20 06/14/2019 W / 3/7/2019 / / / / / / / A / / / / /
27 Carolino, Tricia Mae D. Y 9,1 1/12/2010 F 1.25 16.9 06/14/2019 SW / 3/7/2019 / / / / / / / T / / / / /
H
28 Garcia, Alrean U. Y 8,10 8/18/2010 F 1.21 18 06/14/2019 W / 3/7/2019 / / / / / / / E / / / / /
29 Carvajal, Aaron Joshua A. Y 9,7 1/25/2009 M 1.35 23.4 06/14/2019 W / 3/7/2019 / / / / / / / R / / / / /
30 De Paz, Cyrus M. Y 10,4 2/24/2009 M 1.39 25 06/14/2019 W / 3/7/2019 / / / / / / / / / / / /
31 Sorima, John Ryan A. Y 10,2 1/7/2009 M 1.26 21 06/14/2019 W / 3/7/2019 / / / / / / / / / / / /
32 Virena, Jaybhe R. Y 11,1 11/22/2009 M 1.3 23 06/14/2019 W / 3/7/2019 / / / / / / / / / / / /
33 Arquinoso, Ariane C. Y 11,2 03/27/2009 F 1 24 06/14/2019 W / 3/7/2019 / / / / / / / / / / / /
34 Manaig, Angel Ayesha D. Y 10,9 01/19/2009 F 1.3 21.7 06/14/2019 W / 3/7/2019 / / / / / / / / / / / /
 35 Mendoza, Angel A. Y 10,2 10/13/2009 F 1.31 22.1 06/14/2019 W / 3/7/2019 / / / / / / / / / / / /
36 Aclag, Byance Stanley B. Y 11,1 1/21/2008 M 1.42 27 06/14/2019 W / 3/7/2019 / / / / / / / / / / / /
37 Mendoza, Adrian D. Y 11,2 11/18/2007 M 1.4 25 06/14/2019 W / 3/7/2019 / / / / / / / / / / / /
38 Santos, Angelo James M. Y 10,9 4/30/2008N - Normal1.4 27 06/14/2019 W / 3/7/2019 / / / / / / / / / / /
TOTAL:
Prepared by:
LEGEND
MANNIELLE MAE T. OLIVA A. Nutritional Status
B. Deworming
Feeding Teacher / School Nurse For 6-19 y.o For below 6 y.o
SW - Severely wasted SU - Severely underweight ( x ) - not dewormed
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
ACTUAL FEEDING

15 16 17 18 19 20 21
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 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:

page 2
 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:

page 3
 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
Ht Wt Date Present Days
101 102 ### 104 105 ### ### ### ### 110 111 112 113 114 115 116 117 118 119 120 cm kg Taken NS (A) (B)
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:

page 4
 D. Actual Feeding

( √ ) - Present, served
( A ) - Absent, not served
(√√ ) - Present, served twice

page 4
NDANCE

Percentage

(A/B)*100

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
GRADES AND SECTIONS BEFORE AFTER
Dewormed
SW/SU W/U N Ow Ob Total SW/SU W/U N Ow O 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 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.
PERCENTAGE
ATTENDANCE