SBFP Form 1

Department of Education
Region ___

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

Division/Province: ______________________________________

Name of Principal : ____________________________________

City/ Municipality/Barangay : ____________________________

Name of Feeding Focal Person : _________________________

Name of School / School District : _________________________

Age

No.

Name

Sex

BMI

Date of
in
for 6
Weig Heig
Date of Birth
Weighing /
Years
y.o.
(MM/DD/YYY
Measuring
ht
ht
/
and
Y)
(MM/DD/YYYY
(Kg) (cm)
Mont
abov
)

hs

Nutritio
nal
Disabili
Ethnicity
Status
ty
(NS)

4Ps ID
Number

Name of
Parents

Prepared by:

Noted :

__________________________________
Feeding Focal Person

_____________________________________
School Principal / Officer-in-Charge

Beneficiary of
SBFP in
Previous Years
(yes or no)

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

Number of Undernourished
No. of
School Children by Grade
Severely
Level

Wasted

No. of
Wasted

ofBeneficiaries
Pupils
Ethnicity No.
4 Ps
who are

Total
beneficiaries
Beneficia
in previous
ries No. of Ethnic Ben.
No. of 4 Ps Ben.
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 DepEdHNC

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 ___

SCHOOL-BASED FEEDING PROGRAM (SBFP)

Division/Province: ______________________________________
School District/City/ Municipality : ____________________________

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:

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 ______________________ , SY 2015-2016

Region III
Division BULACAN
District SAN ILDEFONSO SOUTH

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

Tiongson, Shawn Michael

Venturina, John Paul
Dela Cruz, Edliz Kaye E.
Morallano, Erika P.
Serrano, Rhein DR.
Constantino, Jhon Mark B.
Ramos, Jeremie
Lacsinto Christian L.
Santos, April R.
Reyes, Camille Nicole A.
Chavez, Crisamae Kyle SP.
Lacaba, Jerome R.
Enriquez, Queen Angel M.
Simbulan, Shirley R.
Tobias, Apple M.

Vinculado, Arthur Cyrus P.

Gonzales, Hannah D.
Guibo, Analyn G.
San Pedro, Rham Vladimir
Roncal, John Paul
Valdez, Racie Joyce M.
Patatag, Gio Rolly A.
Reyes, Christine Mae M.
Villamil, Rassel Jhayke V.
Dela Cruz, Mary Joy A

4Ps
Beneficiary Beneficiary
(y or n)
of Previous
SBFP
(y or n)

n
n
n
n
n
n
n
n
n
n
n
n
n
n
n
y
n
n
n
n
n
n
n
y
n

School: PINAOD CENTRAL SCHOOL

Grade: __________ Section _____________________

ACTUAL FEEDING

PRE FEEDING
Age

Sex
Birth Date

5,10
6,10
5,10
5,9
6,1
7,4
8,7
6,1
6,1
6,6
8,4
8,6
8,1
7,11
8,4
9,1
8,8
10,8
9,8
10,3
10,7
12,8
10
9,11
12,5

07/25/2009
04/07/2009
07/23/2009
09/01/2009
04/20/2009
01/29/2008
05/11/2006
05/01/2009
04/10/2009
11/14/2008
01/10/2007
11/06/2006
04/27/2007
06/08/2007
01/06/2007
06/05/2015
06/05/2015
06/05/2015
06/05/2015
06/05/2015
06/05/2015
06/05/2015
06/05/2015
06/05/2015
06/05/2015

M
M
F
F
M
M
M
M
F
F
F
M
F
F
F
M
M
M
M
M
F
M
F
F
F

Ht

Nutritional Status
Wt
Date

cm

kg

107
106
106
109
103
117
125
115
114
119
118
128
113
122
121
126
128
136
127
136
130
141
126
138
140

15
14
14
14
14
18
21
16
16
17
18
21
16
19
19
21
21
25
21
20
23
29
21
26
28

NS

Taken
6/5/2015
6/5/2015
6/5/2015
6/5/2015
6/5/2015
6/5/2015
6/5/2015
6/5/2015
6/5/2015
6/5/2015
6/5/2015
6/5/2015
6/5/2015
6/5/2015
6/5/2015
6/5/2015
6/5/2015
6/5/2015
6/5/2015
6/5/2015
6/5/2015
6/5/2015
6/5/2015
6/5/2015
6/5/2015

Deworming
( ) or Date
(X) Taken 1

9 10 11 12 13 14 15 16 17 18 19 20

U
W
U
U
W
W
W
SW
W
W
W
W
W
W
W
W
W
W
W
SW
W
W
W
W
W
TOTAL:

Prepared by:
LEGEND
____________________________
Feeding Teacher / School Nurse

A. Nutritional Status
For 6-19 y.o

For below 6 y.o

B. Deworming

D. Actual Feeding

SW - Severely wasted

SU - Severely underweight

( x ) - not dewormed

( ) - Present, served

W - Wasted

U - Underweight

( ) - dewormed

( A ) - Absent, not served

N - Normal

N - Normal

Ow - Overwieght

Ow - Overwieght

( ) - Present, served twice

O - Obese

Page 7

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

Page 8

SCHOOL-BASED FEEDING PROGRAM

SBFP Form 4
SCHOOL-BASED FEEDING PROGRAM

FOR THE MONTH OF ______________________ , SY 2015-2016

Region III
Division BULACAN
District SAN ILDEFONSO SOUTH

NAME OF PUPIL

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

Vitangcol Emmanuel V.
Gonzales, Roan S.
Interino, Mariel V.
Sanchez, Michaela Nicole A.
Alcoriza, Reniel S.
Colorina, Jenjem E.
Salao, Lady Madelene G.
Sarmiento, Jhaycee P.
Franche, Julius A.
Correa, Jesaline F.
Joson, Nicolette L.
Velacha, Laurice D.
Caratao, Julius W.
Laurente, Gio M.
Ubongen, Charlon I.
Matus, Ronnielyn C.
Tolentino, Nikka F.
Butuhan, Jasper Angelo S.
Catina, Joshua
Guevarra, Delfin B.
Francisco, Ardy L.
Gonzales, Ferdinand Jr. Y.
Dajang Roan R.
Acedera, Angeline L.
Aliermo, Chloe Anne C.

4Ps
Beneficiary Beneficiary
(y or n)
of Previous
SBFP
(y or n)

n
y
n
n
n
y
n
n
n
y
n
n
n
n
n
n
n
n
n
n
y
n
n
y
n

School: PINAOD CENTRAL SCHOOL

Grade: __________ Section _____________________

ACTUAL FEEDING

PRE FEEDING
Age

Sex
Birth Date

12,9
11,9
9,11
10,7
12,4
11,9
11,11
11,2
11,10
15,4
11,4
10,8
12,8
14,2
11,3
14,8
12,9
11,9
11,9
12,5
13,3
11,9
11,10
11,7
11,4

08/14/2002
08/22/2003
06/19/2005
10/10/2004
02/04/2003
08/11/2003
06/17/2003
04/02/2004
08/02/2003
01/11/2000
01/12/2004
10/05/2004
09/14/2002
03/25/2001
02/16/2004
10/03/2000
09/02/2002
08/25/2003
08/07/2003
01/03/2003
06/05/2015
06/05/2015
06/05/2015
06/05/2015
06/05/2015

Ht

Nutritional Status
Wt
Date

cm

M
F
F
F
M
F
F
F
M
F
F
F
M
M
M
F
F
M
M
M
M
M
F
F
F

143
131
116
140
144
141
135
136
134
160
130
136
126
141
144
157
148
128
124
136
124
136
142
128
136

kg

21
23
18
26
30
27
23
25
25
40
23
25
23
29
27
27
28
22
21
27
23
20
26
22
25

NS

Taken
6/5/2015
6/5/2015
6/5/2015
6/5/2015
6/5/2015
6/5/2015
6/5/2015
6/5/2015
6/5/2015
6/5/2015
6/5/2015
6/5/2015
6/5/2015
6/5/2015
6/5/2015
6/5/2015
6/5/2015
6/5/2015
6/5/2015
6/5/2015
6/5/2015
6/5/2015
6/5/2015
6/5/2015
6/5/2015

Deworming
( ) or Date
(X) Taken 1

9 10 11 12 13 14 15 16 17 18 19 20

SW
W
W
W
W
W
SW
W
W
W
W
W
W
W
SW
SW
SW
W
W
W
W
W
W
W
W
TOTAL:

Prepared by:
LEGEND
____________________________
Feeding Teacher / School Nurse

A. Nutritional Status
For 6-19 y.o

For below 6 y.o

B. Deworming

D. Actual Feeding

SW - Severely wasted

SU - Severely underweight

( x ) - not dewormed

( ) - Present, served

W - Wasted

U - Underweight

( ) - dewormed

( A ) - Absent, not served

N - Normal

N - Normal

Ow - Overwieght

Ow - Overwieght

( ) - Present, served twice

O - Obese

Page 9

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

Page 10

SCHOOL-BASED FEEDING PROGRAM

FOR THE MONTH OF ______________________ , SY _____________

SBFP Form 4
SCHOOL-BASED FEEDING PROGRAM

FOR THE MONTH OF ______________________ , SY 2015-2016

Region III
Division BULACAN
District SAN ILDEFONSO SOUTH

School: PINAOD CENTRAL SCHOOL

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 Tiongson, Shawn Michael
2 Venturina, John Paul
3 Dela Cruz, Edliz Kaye E.
4 Morallano, Erika P.
5 Serrano, Rhein DR.
6 Constantino, Jhon Mark B.
7 Ramos, Jeremie
8 Lacsinto Christian L.
9 Santos, April R.
10 Reyes, Camille Nicole A.
11 Chavez, Crisamae Kyle SP.
12 Lacaba, Jerome R.
13 Enriquez, Queen Angel M.
14 Simbulan, Shirley R.
15 Tobias, Apple M.
16 Vinculado, Arthur Cyrus P.
17 Gonzales, Hannah D.
18 Guibo, Analyn G.
19 San Pedro, Rham Vladimirh C.
20 Roncal, John Paul
21 Valdez, Racie Joyce M.
22 Patatag, Gio Rolly A.
23 Reyes, Christine Mae M.
24 Villamil, Rassel Jhayke V.
25 Dela Cruz, Mary Joy A

TOTAL:

D. Actual Feeding
( ) - Present, served
( A ) - Absent, not served
( ) - Present, served twice
page 2

page 2

SBFP Form 4
SCHOOL-BASED FEEDING PROGRAM

FOR THE MONTH OF ______________________ , SY _____________

SBFP Form 4
SCHOOL-BASED FEEDING PROGRAM

FOR THE MONTH OF ______________________ , SY 2015-2016

Region III
Division BULACAN
District SAN ILDEFONSO SOUTH

School: PINAOD CENTRAL SCHOOL

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
26 Vitangcol Emmanuel V.
27 Gonzales, Roan S.
28 Interino, Mariel V.
29 Sanchez, Michaela Nicole A.
30 Alcoriza, Reniel S.
31 Colorina, Jenjem E.
32 Salao, Lady Madelene G.
33 Sarmiento, Jhaycee P.
34 Franche, Julius A.
35 Correa, Jesaline F.
36 Joson, Nicolette L.
37 Velacha, Laurice D.
38 Caratao, Julius W.
39 Laurente, Gio M.
40 Ubongen, Charlon I.
41 Matus, Ronnielyn C.
42 Tolentino, Nikka F.
43 Butuhan, Jasper Angelo S.
44 Catina, Joshua
45 Guevarra, Delfin B.
46 Francisco, Ardy L.
47 Gonzales, Ferdinand Jr. Y.
48 Dajang Roan R.
49 Acedera, Angeline L.
50 Aliermo, Chloe Anne C.

TOTAL:

D. Actual Feeding
( ) - Present, served
( A ) - Absent, not served
page 2

( ) - Present, served twice

page 2

SBFP Form 4
SCHOOL-BASED FEEDING PROGRAM

FOR THE MONTH OF ______________________ , SY _____________

SBFP Form 4
SCHOOL-BASED FEEDING PROGRAM

FOR THE MONTH OF ______________________ , SY 2015-2016

Region III
Division BULACAN
District SAN ILDEFONSO SOUTH

School: PINAOD CENTRAL SCHOOL

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 Tiongson, Shawn Michael
2 Venturina, John Paul
3 Dela Cruz, Edliz Kaye E.
4 Morallano, Erika P.
5 Serrano, Rhein DR.
6 Constantino, Jhon Mark B.
7 Ramos, Jeremie
8 Lacsinto Christian L.
9 Santos, April R.
10 Reyes, Camille Nicole A.
11 Chavez, Crisamae Kyle SP.
12 Lacaba, Jerome R.
13 Enriquez, Queen Angel M.
14 Simbulan, Shirley R.
15 Tobias, Apple M.
16 Vinculado, Arthur Cyrus P.
17 Gonzales, Hannah D.
18 Guibo, Analyn G.
19 San Pedro, Rham Vladimirh C.
20 Roncal, John Paul
21 Valdez, Racie Joyce M.
22 Patatag, Gio Rolly A.
23 Reyes, Christine Mae M.
24 Villamil, Rassel Jhayke V.
25 Dela Cruz, Mary Joy A

TOTAL:

D. Actual Feeding
( ) - Present, served
( A ) - Absent, not served
page 3

( ) - Present, served twice

page 3

SBFP Form 4
SCHOOL-BASED FEEDING PROGRAM

FOR THE MONTH OF ______________________ , SY _____________

SBFP Form 4
SCHOOL-BASED FEEDING PROGRAM

FOR THE MONTH OF ______________________ , SY 2015-2016

Region III
Division BULACAN
District SAN ILDEFONSO SOUTH

School: PINAOD CENTRAL SCHOOL

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
26 Vitangcol Emmanuel V.
27 Gonzales, Roan S.
28 Interino, Mariel V.
29 Sanchez, Michaela Nicole A.
30 Alcoriza, Reniel S.
31 Colorina, Jenjem E.
32 Salao, Lady Madelene G.
33 Sarmiento, Jhaycee P.
34 Franche, Julius A.
35 Correa, Jesaline F.
36 Joson, Nicolette L.
37 Velacha, Laurice D.
38 Caratao, Julius W.
39 Laurente, Gio M.
40 Ubongen, Charlon I.
41 Matus, Ronnielyn C.
42 Tolentino, Nikka F.
43 Butuhan, Jasper Angelo S.
44 Catina, Joshua
45 Guevarra, Delfin B.
46 Francisco, Ardy L.
47 Gonzales, Ferdinand Jr. Y.
48 Dajang Roan R.
49 Acedera, Angeline L.
50 Aliermo, Chloe Anne C.

TOTAL:

D. Actual Feeding
page 3

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

page 3

SBFP Form 4
SCHOOL-BASED FEEDING PROGRAM

FOR THE MONTH OF ______________________ , SY 2015-2016

Region III
Division BULACAN
District SAN ILDEFONSO SOUTH

School: PINAOD CENTRAL SCHOOL

Grade: __________ Section _____________________

ACTUAL FEEDING
NAME OF PUPIL
101 102 ### 104 105 ### ### ### ### ### 111 112 113 114 115 116 117 118 119 120

POST FEEDING
Nutritional Status
Ht
Wt Date
cm
kg Taken NS

ATTENDANCE
Days
Present

Feeding
Days

Percentage

(A)

(B)

(A/B)*100

1 Tiongson, Shawn Michael

2 Venturina, John Paul
3 Dela Cruz, Edliz Kaye E.
4 Morallano, Erika P.
5 Serrano, Rhein DR.
6 Constantino, Jhon Mark B.
7 Ramos, Jeremie
8 Lacsinto Christian L.
9 Santos, April R.
10 Reyes, Camille Nicole A.
11 Chavez, Crisamae Kyle SP.
12 Lacaba, Jerome R.
13 Enriquez, Queen Angel M.
14 Simbulan, Shirley R.
15 Tobias, Apple M.
16 Vinculado, Arthur Cyrus P.
17 Gonzales, Hannah D.
18 Guibo, Analyn G.
19 San Pedro, Rham Vladimirh C.
20 Roncal, John Paul
21 Valdez, Racie Joyce M.
22 Patatag, Gio Rolly A.
23 Reyes, Christine Mae M.
24 Villamil, Rassel Jhayke V.
25 Dela Cruz, Mary Joy A

TOTAL:

AVERAGE:

D. Actual Feeding
( ) - Present, served
( A ) - Absent, not served
( ) - Present, served twice

page 4

page 4

page 4

page 4

SBFP Form 4
SCHOOL-BASED FEEDING PROGRAM

FOR THE MONTH OF ______________________ , SY _____________

Region ____________________________
Division ___________________________
District ___________________________

School: _____________________________________
Grade: __________ Section _____________________

ACTUAL FEEDING
NAME OF PUPIL
101 102 ### 104 105 ### ### ### ### ### 111 112 113 114 115 116 117 118 119 120

POST FEEDING
Nutritional Status
Ht
Wt Date
cm
kg Taken NS

ATTENDANCE
Days
Present

Feeding
Days

Percentage

(A)

(B)

(A/B)*100

26 Vitangcol Emmanuel V.
27 Gonzales, Roan S.
28 Interino, Mariel V.
29 Sanchez, Michaela Nicole A.
30 Alcoriza, Reniel S.
31 Colorina, Jenjem E.
32 Salao, Lady Madelene G.
33 Sarmiento, Jhaycee P.
34 Franche, Julius A.
35 Correa, Jesaline F.
36 Joson, Nicolette L.
37 Velacha, Laurice D.
38 Caratao, Julius W.
39 Laurente, Gio M.
40 Ubongen, Charlon I.
41 Matus, Ronnielyn C.
42 Tolentino, Nikka F.
43 Butuhan, Jasper Angelo S.
44 Catina, Joshua
45 Guevarra, Delfin B.
46 Francisco, Ardy L.
47 Gonzales, Ferdinand Jr. Y.
48 Dajang Roan R.
49 Acedera, Angeline L.
50 Aliermo, Chloe Anne C.

TOTAL:

AVERAGE:

D. Actual Feeding
( ) - Present, served
( A ) - Absent, not served
( ) - Present, served twice

page 4

page 4

SBFP Form 5
SCHOOL-BASED FEEDING PROGRAM

CONSOLIDATED NUTRITIONAL STATUS AND ATTENDANCE REPORT

Region: _______
Division/District: ________________________
School: ________________________________
BEIS ID No.: ___________________________
GRADES AND SECTIONS

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

For below 6 y.o

SU - Severely Underweight
U - Underweight
N - Normal
Ow - Overweight

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