-List of Female Learners per Classroom

School-based Weekly Iron Folic Acid (WIFA) Supplementation

Division: LAGUNA District:________________________ Reporting Month:________________

Name of School:_________________________ Address:_______________________ Date:____________________
Section/Classroom:_____________________ Number of Female Learners:_______ School Year:______________

1st Round 2nd Round Reason why

Consent AUGUST SEPTEMBER OCTOBER JANUARY FEBRUARY MARCH WIFA is not
No. Name of Female Learner Remarks
W1 W2 W3 W4 W1 W2 W3 W4 W1 W2 W3 W4 W1 W2 W3 W4 W1 W2 W3 W4 W1 W2 W3 W4 given (Please)
Y N Indicate Codes #)
1 Antido, Me Ann Aberio
2 Bagolbagol, Jeralyn Cezer
3 Bitoy, Kyla Sorbuna
4 Cabinta, Crystal Anne Macandog
5 Castaňeda, Christine Fernandez
6 Chavez, Chamie Tatel
7 De Rosas, Jaimee Joy Cabansag
8 Doroin, Elizabeth Joy Cabrigas
9 Garganera, Sandara Salinas
10 Maliwanag, Arlie Joy Angana
11 Malabana, Rose Ann Ramos
12 Mallen, Rachell Vocal
13 Mallen, Raquel Vocal
14 Obsiana, Jean Darryl Corcueva
15 Orozco, Nicole Altez
16 Raňola, Princess Ic Merwar
17 Raňosa, Loraine C.
18 Razon, Jasmien Javier
19 Sikat, Anne Krizele D,
20 Villamarzo, Jade Ivee Padayo
TOTAL
***Codes of Reasons why WIFA is not given:
Prepared by: Noted by: 1. not dewormed
2. on therapeutic treatment for anemia
3. with persistent mild reaction like gastric discomfort
Class Adviser Date Grade Level Chairman Date