Republic of the Philippines

SGOD-SHS-NS-021 Rev. 00
DEPARTMENT OF EDUCATION
Region IX, Zamboanga Peninsula
Division of Zamboanga del Sur
Dao, Pagadian City

MASTERLIST OF DEWORMED LEARNERS

SY 20____-20____
School: ____________________________
District : ___________________________ First Round
Grade/Section: _____________________ Second Round
Conditional
Cash Transfer Dewormi Reason, Adverse
Home Address Sex
No. Name of Pupil Age (CCT) ng Status if NOT Event
Beneficiary? deworme Following
M F 4Ps IPs No Yes No d Deworming

SUMMARY: Enrolment Total Dewormed 4PS Ben. IPS Ben. AEFD

5-9 years old
M 10-19 years old
Total
5-9 years old
F 10-19 years old
Total

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Prepared by:
SGOD-SHS-NS-021 Rev. 00
Class Adviser

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