SBFP Form 1 (2023)
Department of Education
Master List Beneficiaries for School-Based Feeding Program (SBFP) ( SY 2022-2023 )
Division / Camarines Sur Name of Princ al
City/ Municipality/Barangay : Name of Feeding Focal Person :
Name of School / School District :
School ID Number:
Parent's Particip
Date of BMI Beneficiary
Age in for 6
Nutritional consent ation in
of SBFP in
Weighing /
No. Grade/ Date of Birth Weight Heigh Status (NS) for milk? 4Ps
Name Sex Measuring Years / y.o. Previous
(MM/DD/YYYY Months (Kg) t (cm) and
Section (MM/DD/YYYY)
Years (yes or
) (yes or (yes or
above no)
BMI-A HFA no) no)
1
2
3
4
5
6
7
8
9
10
11
12
13
14
Prepared by: Approved by:
EDINA B. BANDOLIN PILITA C. APOLINAR
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.
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
No. of Secondary Targets
Number of Overwe No. of 4 No. of 4 Ps
Undernourished School Sex No. of Pupils-at- No. of No. of No. of Learners Beneficiari
Severely ight Severely Stunt Nor risk-of- Stunted/ Indigenou
Children by Grade Level Wasted Normal Tall dropping-out Indigent Dewormed es
Wasted + Stunted ed mal Severely Learners s Peoples
Obese (PARDOs) Stunted (IPs)
1. Kinder F
Total
2. Grade I F
Total
3. Grade II F
M
4. Grade III F
Total
5. Grade IV F
Total
6. Grade V F
Total
7. Grade VI F
Total
Grand Total F
Total
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
submission to DepEd BLSS-SHD
No. of
Pupils who
are Date
beneficiari Feeding
es in
previous Started/En
years ded
(Repeaters
)
lation by the RO, for
SBFP Form 3 (2023)
SCHOOL-BASED FEEDING PROGRAM
RECORD OF DAILY FEEDING
FOR THE MONTH OF _________________, SY ___________________
Region:
SDO: School: _____________________________________
District: School ID Number: _________________________
Grade: __________ Section _____________________
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:
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
ACTUAL FEEDING
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20
Prepared by:
_________EDINA B. BANDOLIN
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
PILITA C. APOLINAR ( 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: 2023-2024)
NAME & DESIGNATION TEL. NO.MOBILE NO. EMAIL ADD SPECIMEN
SIGNATURE
1
2 9272458894
SCHOOL INSPECTION TEAM (SY: (2023-2023)
NAME & DESIGNATION TEL. MOBILE EMAIL ADD SPECIMEN
NO. 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: ______________________________________________________________________________
NAME OF SCHOOL: ______________________________________________________________________________
SCHOOL ID NO.: ______________________________________________________________________________
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
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
SBFP Form 5 (2021)
21
22
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 No. of Packs Received No. of Packs for Remarks
Delivered Replacement/
New Replacement Total (New + Rejected
Replacement)
Kinder M
Total
Grade 1 M
F
Total
Grade 2 M
F
Total
Grade 3 M
F
Total
Grade 4 M
F
SBFP Form 6 (2021)
Total
Grade 5 M
Total
Grade 6 M
Total
M
GRAND TOTAL:
F
Total
Prepared by:
APPROVED BY:
School Feeding Coordinator
School Head
MILK DELIVERIES (SY 2023-2024)
Grade Level Sex Date No. of Packs Received No. of Packs for Remarks
Delivered Replacement/
New Replacement Total (New + Rejected
Replacement)
Kinder M
Total
SBFP Form 6 (2021)
Grade 1 M
Total
Grade 2 M
Total
Grade 3 M
Total
Grade 4 M
Total
Grade 5 M
F
Total
Grade 6 M
F
Total
M
GRAND TOTAL: F
Total
Prepared by: APPROVED BY:
SBFP Form 6 (2021)
School Feeding Coordinator School Head
