SBFP Form 1 (2021)

Department of Education
Region _VII__

Master List Beneficiaries for School-Based Feeding Program (SBFP) (SY_2021-2022_)

Division/Province: __CEBU PROVINCE_____________ Name of Principal : PERINEN D. VILLAHERMOSA

City/ Municipality/Barangay : __TUBOD ,SIBONGA , CEBU___ Name of Feeding Focal Person : ___ANDRESA A. ENGANO___
Name of School / School District : __TUBOD ELEMENTARY SCHOOL_____
School ID Number: ______119724___________________

Nutritional Parent's
BMI for Dewormed? consent for Participation Beneficiary of
Grade/ Date of Weighing / Age in Weight Height 6 y.o. Status (NS) SBFP in
Date of Birth
No. Name Sex Section (MM/DD/YYYY)
Measuring Years / milk? in 4Ps
(MM/DD/YYYY) Months (Kg) (cm) and (yes or no) (yes or (yes or no) Previous Years
above (yes or no)
no)
BMI-A HFA
1 Albor, Daniel K 1/22/2016 5.9 / / NO NO
2 Alipar, John Cielo K 3/30/2016 5.6 / / NO NO
3 Cabuyaon, Ethan K 5/15/2016 5.4 / / NO NO
4 Carbonero, Jimmy K 10/23/2015 5.11 / / NO NO
5 Cirera, Charlou K 1/13/2016 5.9 / / NO NO
6 Cutamora, Rain K 11/17/2015 5.9 / / NO NO
7 Decierdo, Ranel K 9/3/2016 5.1 / / NO NO
8 Decierdo,XanderDrey K 9/5/2016 5.1 / / NO NO
9 Casanes, Micahel Angelo K 9/30/2015 5.11 / / NO NO
10 Estelloso, Bryan Jay K 9/12/2016 5.1 / / NO NO
11 Fernandez, Mark Josh K 9/20/2016 5.1 / / NO NO
12 Jimenez,Ezekiel K 6/29/2016 5.3 / / NO NO
13 Lastimosa, Mark Angelo K 6/26/2016 5.33 / / NO NO
14 Lopez, Zachary Tyler K 5/18/2016 5.4 / / NO NO
15 Manliguez, Crismil K 4/13/2016 5.5 / / NO NO
16 Mirabueno, John Clifford K 3/22/2016 5.6 / / NO NO
17 Mondido, Shamrix Dee K 11/10/21 5.11 / / NO NO
18 Natividad, Ivan Jay K 01/12/16 5.9 / / NO NO
19 Niza, Chris Mark K 7/9/16 5.4 / / NO NO
20 Nombre, Jay K 6/10/16 5.3 / / NO NO
21 Padillo, Nathan Kent K 10/7/15 6 / / NO NO
22 Perry, Jam K 10/16/15 6 / / NO NO
23 Aldava, Stacey Nicole K 4/20/16 5.6 / / NO NO
24 Alegiojo, Nechele K 12/13/15 5.9 / / NO NO
25 Barangan, Nino K 4/15/16 5.6 / / NO NO
26 Canio, Jean K 9/3/15 5.11 / / NO NO
27 Dibalos, Sarah Jane K 11/24/2015 5.11 / / NO NO
28 Elesterio, Katheryn Belle K 1/24/2016 5.9 / / NO NO
29 Gelemisawan, Nina Mae K 2/14/2016 5.8 / / NO NO
30 Jemelisawan, Jessa K 10/15/2015 6 / / NO NO
31 Malait, Rhea Grace K 10/29/2015 5.11 / / NO NO
32 Montefalcon, Alexa K 1/7/2016 5.9 / / NO NO
33 Naason, Judelyn K 6/30/2016 5.4 / / NO NO
34 Natividad, Azy K 8/2/2016 5.3 / / NO NO
35 Natividad, Princess Nina K 1/31/2016 5.8 / / NO NO
36 Oporto, Zelinah K 4/1/2016 5.5 / / NO NO
37 Paller, Nina Margarit K 1/9/2016 5.8 / / NO NO
38 Pilarca, Harlyn K 11/21/2015 5.11 / / NO NO
39 Pilarca, Princess Nicole K 2/29/2016 5.8 / / NO NO
40 Pobalacion, Diana K 9/27/2016 5.3 / / NO NO
41 Santarita, Urea Mae K 3/29/2016 5.6 / / NO NO
42 Santiago, Rhea Chloe K 7/4/2016 5.3 / / NO NO
43 Solatorio, Ashley Joy K 4/26/2016 5.6 / / NO NO
44 Suerte, Chris Angel K 11/20/2015 5.11 / / NO NO
45 Villar, Princess Ann K 1/25/2016 5.9 / / NO NO
46 Casanes, Mitch G-1 5/6/2015 5/14/2021 6.5 14 1.09 10.21 SW / / NO YES
47 Lumacang, Dannice G-1 7/29/2015 5/14/2021 6.3 15 1.1 10.12 W / / NO YES
48 Engano, Clint G-1 5/31/2015 5/14/2021 6.5 15 1.08 10.08 SW / / NO YES
49 Decierdo, Lyka G-2 10/15/2015 5/14/2021 7 16 1.11 11.2 W / / NO YES
50 Quinto, Johnlynon G-2 10/10/2013 5/14/2021 7 17 1.18 11.21 W / / NO NO
51 Montifalcon, Kim G-3 4/1/2012 5/14/2021 8.3 16 1.15 11.31 W / / NO NO
52 Alquizar , Jake G-3 4/25/2013 5/14/2021 8.3 17 1.11 12.02 W / / NO NO
53 Rellon , Fatima G-3 5/10/2013 5/14/2021 8.2 15 1.09 11.23 W / / NO NO
54 Engano, Cyriel G-3 11/10/2012 5/14/2021 8.11 17 1.17 11.32 W / / NO YES
55 Madaiton, Jeff Matthew G-4 5/11/2011 5/14/2021 9.4 19 1.21 12.25 W / / YES YES
56 Quinto, Carla Ann G-5 4/17/2011 5/14/2021 10.5 18 1.23 12.5 W / / NO YES
 57 Natividad, Ian dave G-5 12/13/2010 5/14/2021 10.9 18 1.2 11.21 W / / NO NO

Approved by:

ANDRESA A. ENGANO PERINEN D. VILLAHERMOSA

Feeding Focal Person School Head

Note: This form shall be prepared by the school before the start of feeding to be compiled by the SDO.
Keep columns 6-12 blank if nutritional assesment is still suspended.
SBFP Form 2 (2021)
Department of Education
Region _VII__

SCHOOL-BASED FEEDING PROGRAM (SBFP) SUMMARY OF BENEFICIARIES & START OF FEEDING (SY__2021-2022__)
Division/Province: ____CEBU PROVINCE__________
City/ Municipality/Barangay : ___ TUBOD, SIBONGA, CEBU
Name of School / School District : _ TUBOD ELEMENTARY SCHOOL
School ID Number: ____119724_____________________
Date of Start of Feeding: _________ 10/25/2021

Nutritional Status at Start/End of Feeding No. of Secondary Targets No. of 4 No. of 4 Ps No. of Pupils Date Feeding
Learners Beneficiaries who are Started/Ended
SW W N OW+O SS S N T No. of Pupils- No. of No. of No. of Dewormed beneficiaries
Number of Undernourished School at-risk-of- Stunted/ Indigent Indigenous in previous
Children by Grade Level dropping-out Severely Learners Peoples (IPs) years
(PARDOs) (Repeaters)
Stunted

1. Kinder 0 0 0 0 0 0 0 45 0 0 0 0 45 0 0 10/25/2021

2. Grade I 2 1 0 0 0 0 0 3 0 0 0 0 3 0 2

3. Grade II 0 2 0 0 0 0 0 2 0 0 0 0 2 0 0

4. Grade III 0 4 0 0 0 0 0 4 0 0 0 0 4 0 0

5. Grade IV 0 1 0 0 0 0 0 1 0 0 0 0 1 0 0

6. Grade V 0 2 0 0 0 0 0 2 0 0 0 0 2 0 1

7. Grade VI 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0

Total 2 10 0 0 0 0 0 57 0 0 0 0 57 0 1

Prepared by: Approved by:

ANDRESA A. ENGANO PERINEN D. VILLAHERMOSA

SBFP 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 submission to DepEd BLSS-SHD
 SBFP Form 3 (2021)
SCHOOL-BASED FEEDING PROGRAM
RECORD OF DAILY FEEDING

FOR THE MONTH OF ______________________ , SY _____________

Region ____________________________
Division ___________________________ School: _____________________________________
District ___________________________ Grade: __________ Section _____________________
School ID Number: _________________________
NAME OF PUPIL ACTUAL FEEDING

1 2 3 4 5 6 7 8 9 10 11 12 13 14 15
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:
 ____________________________
B. Deworming D. Actual Feeding
Feeding Teacher / School Nurse
( 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
( A ) - Absent, not served
School Head (H2/M2/(H/M2)) - Present, served twice

Note: This form shall be prepared by the school to be consolidated using the Revised OKD Form A.
16 17 18 19 20
 SBFP Form 3 (2021)

SCHOOL-BASED FEEDING PROGRAM

FOR THE MONTH OF ______________________ , SY _____________

Region ____________________________
Division ___________________________ School: _____________________________________
District ___________________________ Grade: __________ Section _____________________
School ID Number: _________________________

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
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

(H ) - Present, served with Hot meals

(M ) - Present, served with Milk
(H/M ) - Present, served with Hot meals & Milk
( A ) - Absent, not served
(H2/M2/(H/M2)) - Present, served twice

page 2
53 54 55 56 57 58 59 60

page 2
 SBFP Form 3 (2021)

SCHOOL-BASED FEEDING PROGRAM

FOR THE MONTH OF ______________________ , SY _____________

Region ____________________________
Division ___________________________ School: _____________________________________
District ___________________________ Grade: __________ Section _____________________
School ID Number: _________________________

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
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

(H ) - Present, served with Hot meals

(M ) - Present, served with Milk
(H/M ) - Present, served with Hot meals & Milk
( A ) - Absent, not served
(H2/M2/(H/M2)) - Present, served twice

page 3
93 94 95 96 97 98 99 100

page 3
 SBFP Form 3 (2021)

SCHOOL-BASED FEEDING PROGRAM

FOR THE MONTH OF ______________________ , SY _____________

Region ____________________________
Division ___________________________ School: _____________________________________
District ___________________________ Grade: __________ Section _____________________
School ID Number: _________________________

ACTUAL FEEDING
ATTENDANCE
NAME OF PUPIL No. of
Days
Present
101 102 103 104 105 106 107 108 109 110 111 112 113 114 115 116 117 118 119 120 (A)
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

(H ) - Present, served with Hot meals

(M ) - Present, served with Milk
(H/M ) - Present, served with Hot meals & Milk
( A ) - Absent, not served
(H2/M2/(H/M2)) - Present, served twice

page 4
ATTENDANCE
No. of
Feeding Percentage
Days
(B) (A/B)*100

AVERAGE:

page 4
SBFP Form 5 (2020)

DEPARTMENT OF EDUCATION
Region ____

REGION/DIVISION/DISTRICT: ____________________________________________________________________
NAME OF SCHOOL: ____________________________________________________________________
SCHOOL ID NO.: ____________________________________________________________________

SCHOOL-BASED FEEDING PROGRAM - MILK COMPONENT

LIST OF AUTHORIZED CONSIGNEES (SY________)

NAME & DESIGNATION TEL. NO. MOBILE NO. EMAIL ADD SPECIMEN
SIGNATURE
1 (School Head)

2 (School Feeding Coordinator)

3 (School Property Custodian)

SCHOOL INSPECTION TEAM (SY________)

NAME & DESIGNATION TEL. NO. MOBILE NO. EMAIL ADD SPECIMEN
SIGNATURE
1

3
SBFP Form 5 (2020)

Note: Only authorized consignees are allowed to receive the goods.

SBFP Form 5 (2021)

DEPARTMENT OF EDUCATION
Region ___

REGION/DIVISION/DISTRICT: ______________________________________________________________________________
NAME OF SCHOOL: ______________________________________________________________________________
SCHOOL ID NO.: ______________________________________________________________________________

SCHOOL-BASED FEEDING PROGRAM - MILK COMPONENT

LIST OF BENEFICIARIES (SY________)

Classification of Students in terms of Milk Tolerance
(Please check one)
Without milk With milk Not allowed by
intolerance and will intolerance but parents to
Name Grade & Section participate in milk willing to participate in milk
feeding participate in milk feeding
feeding
SBFP Form 5 (2021)

Prepared by: APPROVED BY:

School Feeding Coordinator School Head

SBFP Form 6 (2021)

DEPARTMENT OF EDUCATION
Region ___

REGION/DIVISION/DISTRICT: ______________________________________________________________________________
NAME OF SCHOOL: ______________________________________________________________________________
SCHOOL ID NO.: ______________________________________________________________________________

SCHOOL-BASED FEEDING PROGRAM

NFP DELIVERIES (SY________)

Grade Level Number of Beneficiaries Date No. of Packs Received No. of Packs for Remarks
Delivered Replacement/
New Replacement Total (New + Rejected
Replacement)
Kinder
Grade 1
Grade 2
Grade 3
Grade 4
Grade 5
Grade 6
TOTAL:

MILK DELIVERIES (SY________)

Grade Level Number of Beneficiaries Date No. of Packs Received No. of Packs for Remarks
Delivered Replacement/
New Replacement Total (New + Rejected
Replacement)
Kinder
Grade 1
Grade 2
Grade 3
Grade 4
Grade 5
Grade 6
TOTAL:
SBFP Form 6 (2021)

Prepared by: APPROVED BY:

School Feeding Coordinator School Head