SBFP Form 1

Department of Education
Region IV-A

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

Division/Province: Batangas City / Batangas Name of Principal : Mercy G. Baes

City/ Municipality/Barangay : Batangas City / San Jose Sico Name of Feeding Focal Person : Shelly B. Alday
Name of School / School District : San Jose Sico Elementary School / District 1

BMI Participation
Date of Weighing / Age in Weight Height for 6 Beneficiary of SBFP
Date of Birth Nutritional Status in 4Ps
No. Name Sex Measuring Years / y.o. Name of Parents in Previous Years
(MM/DD/YYYY) (MM/DD/YYYY) Months (Kg) (cm) and (NS) (yes or
no) (yes or no)
above

Grade 6
1 Perez, Ronald RJ S. M 01/17/06 9/6/2017 11,4 26 143 12.7 Severely Wasted No Ronaldo Perez No
2 Victoriano, Renie Rhy R. M 10/28/05 9/6/2017 11,7 22 132 12.6 Severely Wasted No Rica Victoriano No
3 Balisco, Charity R. F 12/30/05 9/6/2017 11,5 21 130 12.4 Severely Wasted No Ray Balisco No
4 Macalalad, Hanna Karyl A. F 04/16/06 9/6/2017 11,1 21 130 12.4 Severely Wasted No Wenifredo Macalalad No
5 Mandapat, Mary Jane C. F 06/03/06 9/6/2017 11 21 130 12.4 Severely Wasted No Romer Mandapat Yes

Prepared by:

SHELLY B. ALDAY
School Feeding Coordinator

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 DepEd-HNC
SBFP Form 1
Department of Education
Region IV-A

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

Division/Province: Batangas City / Batangas Name of Principal : Mercy G. Baes

City/ Municipality/Barangay : Batangas City / San Jose Sico Name of Feeding Focal Person : Shelly B. Alday
Name of School / School District : San Jose Sico Elementary School / District 1

BMI Participation
Date of Weighing / Age in Weight Height for 6 Nutritional in 4Ps Beneficiary of SBFP
Date of Birth
No. Name Sex Measuring Years / y.o. Name of Parents in Previous Years
(MM/DD/YYYY) Months (Kg) (cm) and Status (NS) (yes or
(MM/DD/YYYY)
no) (yes or no)
above

Kinder
1 Ebora, Daniel Simon H. M 11/28/11 9/6/2017 66 mon 14.5 102 1.02 Wasted No Melvin Alison Ebora No
Grade 1
2 Celzo, Krisha Mae G. F 04/23/11 9/6/2017 6,1 14.3 110 11.80 Wasted No Carlos Celzo Jr. Yes
3 Panganiban, Frinces An N. F 05/21/11 9/6/2017 6,0 15 110 12.30 Wasted No Enrique Panganiban Yes
4 Perez, Celyn Rave D. F 01/09/11 9/6/2017 6,5 17.5 120 12.10 Wasted No Celestino Perez No
Grade 2
5 Aldover, Mark Jay Lemon M 02/10/10 9/6/2017 7,4 16.5 113 12.90 Wasted No Marlon Aldover Yes
Grade 4
6 Funtanilla, John Paul Alas M 02/08/07 9/6/2017 10,4 21 125 13.40 Wasted No Bernard Funtanilla No
7 Mendoza, Michael Andrew Guillo M 11/23/07 9/6/2017 9,6 21 125 13.40 Wasted No Fernando Mendoza Yes
Grade 5
8 Gantia, Jimuel Irinco M 12/15/04 9/6/2017 12,6 29 141 14.50 Wasted No Joeffry Gantia No
9 Ocampo, John Gabriel Villar M 10/07/07 9/6/2017 9,8 22 129 13.20 Wasted No Mario Ocampo Yes
10 Perez, Ronald Andrew Sumanga M 10/30/07 9/6/2017 9,7 26.5 142 13.10 Wasted No Ronaldo Perez Yes
11 Durana, Edlyn Barrion F 12/04/06 9/6/2017 10,6 24.7 136 13.30 Wasted No Edson Durana No
12 Magtibay, Honey Rose Manalo F 05/21/07 9/6/2017 10 20 126 12.50 Wasted No Ben Magtibay Yes
Grade 6
13 Ravela, Charles Castos M 04/10/06 9/6/2017 11,2 24.8 133 14.00 Wasted No Ernesto Ravela Yes
14 Cornejo, Rodieleen Valentin F 12/30/05 9/6/2017 11,5 23.6 130 13.90 Wasted No Rodolfo Cornejo Yes
 15 Davalos, Alen Joy Suarez F 11/16/05 9/6/2017 11,6 25.6 137 13.60 Wasted No Leoncio Davalos Yes
16 Dujapa, Jessa Mae B. F 07/14/06 9/6/2017 10,11 21.7 127 13.40 Wasted No Jessie Dujapa No
17 Zamora, Andrew Noel P. M 12/17/05 9/6/2017 11,5 24 133 13.50 Wasted No Eligio Zamora No
18 Amorez, Aiza Kolen C. F 04/09/06 9/6/2017 11,2 26 137 13.80 Wasted No Rolando Amores No
19 Dimapilis, Lexi Ashley D. F 11/05/05 9/6/2017 11,7 25 136 13.50 Wasted No Bernard Dimapilis No
20 Lodhi, Nida M. F 09/20/04 9/6/2017 12,8 35 157 14.10 Wasted No Amir Lodhi Yes
21 Magtolis, Ruth E. F 03/07/06 9/6/2017 11,3 23 132 13.20 Wasted No Joseph Magtolis No
22 Pajarillano, Aicon Ella Y. F 09/07/06 9/6/2017 10,9 26 140 13.20 Wasted No Leo Pajarillano No

Prepared by:

SHELLY B. ALDAY
School Feeding Coordinator

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 DepEd-HNC
SBFP Form 2
Department of Education
Region IV-A

SCHOOL-BASED FEEDING PROGRAM (SBFP) LIST OF SCHOOLS

Division/Province: Batangas City / Batangas

School District/City/ Municipality : District 1 / Batangas City

Name of District
Name of Schools BEIS ID No. School Address Name of Barangay Supervisors/ Contact Number Total Beneficiaries
School Principal or OICs

San Jose Sico Elementary School 109555 San Jose Sico, Batangas City San Jose Sico Mercy G. Baes 09755336334 5 Severely Wasted
San Jose Sico Elementary School 109556 San Jose Sico, Batangas City San Jose Sico Mercy G. Baes 09755336334 22 Wasted

Prepared by: Noted by:

SHELLY B. ALDAY MERCY G. BAES

School Feeding Coordinator Principal I

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 3
Department of Education
Region IV-A

SCHOOL-BASED FEEDING PROGRAM (SBFP) SUMMARY OF BENEFICIARIES & START OF FEEDING

Division/Province: Batangas City / Batangas
City/ Municipality/Barangay : Batangas City / San Jose Sico
Name of School / School District : San Jose Sico Elementary School / District 1

Date of Start of Feeding: __________________________

Nutritional Status at Start of Feeding

Number of Undernourished School
Children by Grade Level No. of No. of Pupils who
Severely No. of Total No. of 4 Ps are beneficiaries in
Wasted Wasted Beneficiaries Beneficiaries previous years Remarks

0 1 1 0 0
1. Kinder

0 3 3 0 2
2. Grade I

0 1 1 0 1
3. Grade II

0 0 0 0 0
4. Grade III

0 2 2 0 1
5. Grade IV

0 5 5 0 3
6. Grade V

5 10 15 0 4
7. Grade VI

Total 5 22 27 0 11

Prepared by:

SHELLY B. ALDAY
School Feeding Coordinator

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 DepEd-HNC
 SBFP Form 4
SCHOOL-BASED FEEDING PROGRAM
RECORD OF DAILY FEEDING

FOR THE MONTH OF ______________________ , SY _____________

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

ACTUAL FEEDING
PRE FEEDING
4Ps
NAME OF PUPIL Beneficiary Beneficiary Nutritional Status Deworming
(y or n) of Previous Ht Wt Date
SBFP
Age Birth Sex (√ ) or Date
NS
(y or n) Date cm kg Taken (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
____________________________ A. Nutritional Status
B. Deworming D. Actual Feeding
Feeding Teacher / School Nurse For 6-19 y.o For below 6 y.o
SW - Severely wasted SU - Severely underweight ( x ) - not dewormed ( √ ) - Present, served
W - Wasted U - Underweight ( √ ) - dewormed ( A ) - Absent, not served
N - Normal N - Normal (√√ ) - Present, served twice
Ow - Overwieght Ow - Overwieght
O - Obese

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

Page 7
 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:

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:

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
Percentage
Ht Wt Date Present Days
101 102 ### 104 105 ### ### ### ### ### 111 112 113 114 115 116 117 118 119 120 cm kg Taken NS (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. Actual Feeding

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

page 4
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