Form 1 - Classroom Level Annex A1

School-based Weekly Iron Folic Acid (WIFA) Supplementation

Region: I Division: Urdaneta City Division Date: JULY 10,2019 School Year: 2019-2020
School ID: 300410 Name of School: Urdaneta City National High School Address: San Vicente West, Urdaneta City, Pangasinan
Grade Level/Section: 11-ABM-TAYLOR Number of Students Enrolled: 40 Number of Female Learners: 32
Round 1: Round 2:
Consent Provided With Iron Folic Acid Supplements
Month of July Month of August Month of September
LRN Name of Learner With Without
Consent Consent W1 W2 W3 W4 W5 W1 W2 W3 W4 W1 W2 W3 W4 W5
ACOSTA, DEA JACQUELINE NICOLE 07/01/2019 07/08/2019 07/15/2019 07/22/2019 07/29/2019 08/05/2019 08/12/2019 08/19/2019 08/26/2019 09/02/2019 09/09/2019 09/16/2019 09/23/2019 09/30/2019

1 102283080012 MANTOLINO √ √ √ √ √ √ √ √ √ √ √ √ √ √ √
2 102297080006 ALBAY, DONNA GAYLE SABADO √ √ √ √ √ √ √ √ √ √ √ √ √ √ √
3 102271080004 ALNAS, DAPHNIE NILO √ √ √ √ √ √ √ √ √ √ √ √ √ √ √
4 102283080043 ALVAREZ, BERNADETTE ASTELERO √ √ √ √ √ √ √ √ √ √ √ √ √ √ √
5 102271080012 BLANCO, KYLE
BONGALON, CATHERINE
BRIGITTE AGAS
SOL DE √ √ √ √ √ √ √ √ √ √ √ √ √ √ √
6 102283080106 DIOS √ √ √ √ √ √ √ √ √ √ √ √ √ √ √
7 101792080008 CARAULIA,
DE GUZMAN, CIARA MAY DANTES
KRISTINE √ √ √ √ √ √ √ √ √ √ √ √ √ √ √
8 104567080049 BARTOLOME
DELA CRUZ, HONEY LYN √ √ √ √ √ √ √ √ √ √ √ √ √ √ √
9 102276080029 GALLARDO √ √ √ √ √ √ √ √ √ √ √ √ √ √ √
10 102294080005 ECABEZA, BABYLYN LIBRADO √ √ √ √ √ √ √ √ √ √ √ √ √ √ √
11 101780080025 ESTEVES, ROCEL PABLO √ √ √ √ √ √ √ √ √ √ √ √ √ √ √
12 102278080038 ESTRADA, JANEKA DISMAYA √ √ √ √ √ √ √ √ √ √ √ √ √ √ √
13 102299080070 EUGENIO, JENNIFER √ √ √ √ √ √ √ √ √ √ √ √ √ √ √
14 101769080022 JANELLE RAMIREZ
FERNANDEZ, RICHELLE BELLE √ √ √ √ √ √ √ √ √ √ √ √ √ √ √
15 101769080025 LAROYA √ √ √ √ √ √ √ √ √ √ √ √ √ √ √
16 300410160010 GUERERO, MELODY HELLER √ √ √ √ √ √ √ √ √ √ √ √ √ √ √
17 108421140005 IBARRETA, ARVY
JAVONILLO, CYRIL BANDAL
KYLE √ √ √ √ √ √ √ √ √ √ √ √ √ √ √
18 102291080033 CASTANETO √ √ √ √ √ √ √ √ √ √ √ √ √ √ √
19 102283130762 LALA, NORHATA COTONGAN √ √ √ √ √ √ √ √ √ √ √ √ √ √ √
20 102130080020 MAGANES, ASHLEY
MANONGSONG, PASCUA
ROGELYN √ √ √ √ √ √ √ √ √ √ √ √ √ √ √
21 102283080372 DEOGRACIAS √ √ √ √ √ √ √ √ √ √ √ √ √ √ √
22 101783080023 MASE, CHARIZE
MORALES, JHOANASANTE
CARLA √ √ √ √ √ √ √ √ √ √ √ √ √ √ √
23 101780080050 MOLINA √ √ √ √ √ √ √ √ √ √ √ √ √ √ √
24 102284080022 PAA, LHESLIE ANN PADRON √ √ √ √ √ √ √ √ √ √ √ √ √ √ √
25 101864080074 PADILLA, MARJORIE OLIVA √ √ √ √ √ √ √ √ √ √ √ √ √ √ √
26 102283120814 PALAD, ODYNN NICKOLE ESPEJO √ √ √ √ √ √ √ √ √ √ √ √ √ √ √
27 101792080027 PETERO, ERICA BABIERA √ √ √ √ √ √ √ √ √ √ √ √ √ √ √
28 102278080079 SIMON, MAY ANN VISTA √ √ √ √ √ √ √ √ √ √ √ √ √ √ √
29 101783080037 SIQUIG,
SORIANO,REGINE JOY EVANGELISTA
BERNADETH DELOS √ √ √ √ √ √ √ √ √ √ √ √ √ √ √
30 102283080533 SANTOS √ √ √ √ √ √ √ √ √ √ √ √ √ √ √
31 102291080075 SORIANO, ENALYN REJUSO √ √ √ √ √ √ √ √ √ √ √ √ √ √ √
32 102306080095 TUATIS, BEVERLYN AGACITA √ √ √ √ √ √ √ √ √ √ √ √ √ √ √

Administered by: Noted by:

NORMAN T. SAMERA NORMAN T. SAMERA LYRA JUNE G. MATA
Homeroom Sponsor Class Adviser Class Adviser
JULY 10, 2019 Date:
Annex A1

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