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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

hs

Prepared by:

__________________________________
Feeding Focal Person

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
)

e

Participa
Nutritio
tion in
nal
4Ps
Status
(NS)
(yes or
no)

Name of
Parents

Beneficiary of
SBFP in
Previous Years
(yes or no)

Note: This form shall be prepared by the school. and for final compilation by the RO. to be compiled by the DO. for submission to DepEd-HNC .

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 .SBFP Form 2 Department of Education Region ___ SCHOOL-BASED FEEDING PROGRAM (SBFP) LIST OF SCHOOLS Division/Province: ______________________________________ School District/City/ Municipality : ____________________________ Name of Schools BEIS ID No.

for submission to DSWD-FO. for final consolidation by the RO.Note: This form shall be prepared by the DO. copy furnished DepEd-HNC .

Grade VI Total Prepared by: ______________________________________ SBFP DepEd Focal Note: This form shall be prepared by the school. of Wasted Total Beneficiar No. Grade III 5. and for final compilation by the RO. of School Children by Grade Severely Level Wasted No. of 4 Ps Beneficiaries ies No.SBFP Form 3 Department of Education Region ___ SCHOOL-BASED FEEDING PROGRAM (SBFP) SUMMARY OF BENEFICIARIES & START OF FEEDING Division/Province: ______________________________________ City/ Municipality/Barangay : ____________________________ Name of School / School District : _________________________ Date of Start of Feeding: __________________________ Nutritional Status at Start of Feeding Number of Undernourished No. Kinder 2. Grade V 7. Grade II 4. for submission to DepEd-HNC . of Pupils who are beneficiaries in previous years Remarks 1. to be compiled by the DO. Grade I 3. Grade IV 6.

to be compiled by the DO. and for final compilation by the RO.Note: This form shall be prepared by the school. for submission to DepEd-HNC .

Actual Feeding SW .Present. Nutritional Status For 6-19 y.SBFP Form 4 SCHOOL-BASED FEEDING PROGRAM RECORD OF DAILY FEEDING FOR THE MONTH OF ______________________ .Severely wasted SU . SY _____________ Region ____________________________ Division ___________________________ District ___________________________ NAME OF PUPIL 4Ps Beneficiary Beneficiary (y or n) of Previous SBFP (y or n) School: _____________________________________ Grade: __________ Section _____________________ ACTUAL FEEDING PRE FEEDING Age Birth Date Sex Ht Nutritional Status Wt Date cm kg Taken NS Deworming (√ ) or Date (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 ____________________________ Feeding Teacher / School Nurse A. served W .Severely underweight ( x ) . Deworming For below 6 y.not dewormed ( √ ) .Normal Ow . served twice O .Underweight ( √ ) .dewormed ( A ) .Absent. not served N .Overwieght (√√ ) .o B.Overwieght Ow .Obese Page 7 .Present.o D.Wasted U .Normal N .

Note: This form shall be prepared by the school to be consolidated using SBFP Form 5 Page 8 .

SBFP Form 4 SCHOOL-BASED FEEDING PROGRAM FOR THE MONTH OF ______________________ . served ( A ) . Actual Feeding ( √ ) . SY _____________ Region ____________________________ Division ___________________________ District ___________________________ 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 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.Present. not served (√√ ) .Present.Absent. served twice page 2 .

Present.Absent. served twice page 3 . SY _____________ Region ____________________________ Division ___________________________ District ___________________________ 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 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.SBFP Form 4 SCHOOL-BASED FEEDING PROGRAM FOR THE MONTH OF ______________________ .Present. Actual Feeding ( √ ) . not served (√√ ) . served ( A ) .

served twice page 4 . not served (√√ ) . 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 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: D.SBFP Form 4 SCHOOL-BASED FEEDING PROGRAM FOR THE MONTH OF ______________________ .Absent.Present. served ( A ) .Present. Actual Feeding ( √ ) .

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