C

Department of Education
Region _I__

Master List Beneficiaries for School-Based Feeding Program (SBFP) (SY 2021-2022)

Division/Province: San Carlos City/ Pangasinan Name of Principal : Camilo P. Bulatao

City/ Municipality/Barangay : San Carlos City/ Cobol Name of Feeding Focal Person : Julieta P. Mondares
Name of School / School District : Ignacio Centeno Elementary School/District II-B
School ID Number: 102229

Nutritional Parent's
BMI for Dewormed? consent for Participation Beneficiary of
Grade/ Date of Birth Date of Weighing / Age in Weight Height 6 y.o. Status (NS) SBFP in
No. Name Sex Section
Measuring Years / milk? in 4Ps
(MM/DD/YYYY) (MM/DD/YYYY) Months (Kg) (cm) and
(yes or no) (yes or (yes or no)
Previous Years
above no) (yes or no)
BMI-A HFA
131 Mendoza, Shezel V. F Gr.V 5/18/2011 yes no yes
132 Boquiren, Marion M. M Gr.VI 6/6/2010 yes no yes
133 Castaneda, Eddie Boy R. M Gr.VI 1/28/2009 yes yes yes
134 De Guzman, Jericho D. M Gr.VI 1/8/2010 yes no yes
135 Cabuang, John Christian P. P. Kinder 6/21/2016 yes no yes
136 Mendoza,Vance Althea S. F Kinder 9/23/2016 yes yes yes
137 De vera, Aica Mae C. F Kinder 7/18/2015 yes yes yes

Prepared by: Approved by:

CAMILO P. BULATAO
JULIETA P. MONDARES School Head
Feeding Focal Person

Note: This form shall be prepared by the school before the start of feeding to be compiled by the SDO.
Keep columns 6-12 blank if nutritional assesment is still suspended.
 SBFP Form 3 (2021)

SCHOOL-BASED FEEDING PROGRAM ( MILK )

FOR THE MONTH OF October 11-November 22, 2021, SY 2021-2022

Region : I
Division : San Carlos City, Pangasinan School: Ignacio Centeno Elementary School
District : II-B Grade: Kinder to Grade VI
School ID Number: 102229

ACTUAL FEEDING
ATTENDANCE
NAME OF PUPIL No. of No. of
Days Feeding Percentage
10/11-15/2021 10/18-22/2021 10/25-29/2021 11/2-5/2021 11/8-12/2021 11/15-19/2021 11/22-24/2021 Present Days
5 packs 5 packs 5 packs 5 packs 5 packs 5 packs 3 packs (A) (B) (A/B)*100
1 Estacio,Arjohn V.
2 Neri,Brix V.
3 Sumera,Allan D.
4 Ferrer,Rangie S.
5 Samberi,Jim F.
6 Valdez,Justin Clark P.
7 De Santos,Mark Jian P.
8 Ancheta,Muhammad Ahmed
9 Criste, Gerald Xander Y.
10 Dellova, Ezekel L.
11 Domantay,Martin Jr. Z.
12 Ferrer,Jhonel B.
13 Ramos, Sean D.
14 Reyes,Matt Ezekiel C.
15 Salting,John Noel A.
16 Santos,Jovinson F.
17 Ferrer, Jacky N.
18 Bulatao, Abegail
19 Samberi, Mae M.
20 Lagunday, Kassandra
21 Austria, Pia Maine M.
22 Vergara, Sofia Kate C.
23 Ducusin, Aishanelle M.
24 Audije,Maeganne Erin C.
25 Austria,Axel Shin M.
TOTAL: AVERAGE:

D. Actual Feeding

(H ) - Present, served with Hot meals

(M ) - Present, served with Milk
(H/M ) - Present, served with Hot meals & Milk
( A ) - Absent, not served
(H2/M2/(H/M2)) - Present, served twice

page 4
 SBFP Form 3 (2021)

SCHOOL-BASED FEEDING PROGRAM ( MILK )

FOR THE MONTH OF October 11-November 22, 2021, SY 2021-2022

Region : I
Division : San Carlos City, Pangasinan School: Ignacio Centeno Elementary School
District : II-B Grade: Kinder to Grade VI
School ID Number: 102229

ACTUAL FEEDING
ATTENDANCE
NAME OF PUPIL No. of No. of
Days Feeding Percentage
P 10/18-22/2021 10/25-29/2021 11/2-5/2021 11/8-12/2021 11/15-19/2021 11/22-24/2021 Present Days
5 packs 5 packs 5 packs 5 packs 5 packs 5 packs 3 packs (A) (B) (A/B)*100
26 Seguisa, Ma. Paulene
27 Tan, Josie Ann
28 Ancheta, Kenshin Jade
29 Boquiren, Kyle Estephen L.
30 Junio, Caleb Josh D.
31 Ferrer, Jay-Dee T.
32 Ferrer, Khris Derick L.
33 Mendoza, Harold S.
34 Mendoza,Ralph Vander T.
35 Mendoza, Xynon Arceus C.
36 Gundayao, Chadric Josh T.
37 Reyes, Din Cyrus F.
38 Canta, Jomar D.
39 Ancheta,Xiamara Annika A.
40 Aquino,Liza C.
41 Aquino,Sarah O.
42 Cabral, Colleen Elizabeth D.
43 De Guzman, Mariebeth D.
44 Dolor, Khate Sofia D.
45 Garcillian,Kyrie Yen S.
46 Gundayao, Reanna Marie M.
47 Layno,Leiziah O.
48 Luciano, Margaux D.
49 Solomon,Khandra Maine R.
50 Solomon,Venice Hayley T.
TOTAL: AVERAGE:

D. Actual Feeding

(H ) - Present, served with Hot meals

(M ) - Present, served with Milk
(H/M ) - Present, served with Hot meals & Milk
( A ) - Absent, not served
(H2/M2/(H/M2)) - Present, served twice

page 4
 SBFP Form 3 (2021)

SCHOOL-BASED FEEDING PROGRAM ( MILK )

FOR THE MONTH OF October 11-November 22, 2021, SY 2021-2022

Region : I
Division : San Carlos City, Pangasinan School: Ignacio Centeno Elementary School
District : II-B Grade: Kinder to Grade VI
School ID Number: 102229

ACTUAL FEEDING
ATTENDANCE
NAME OF PUPIL No. of No. of
Days Feeding Percentage
10/11-15/2021 10/18-22/2021 10/25-29/2021 11/2-5/2021 11/8-12/2021 11/15-19/2021 11/22-24/2021 Present Days
5 packs 5 packs 5 packs 5 packs 5 packs 5 packs 3 packs (A) (B) (A/B)*100
51 Torres,Khaela Jannah S.
52 Zapanta,Janine D.
53 Doria, Jenny F.
54 Repato,Mark Rhenz P.
55 Tibay, Gabriel C.
56 De Vera, John Rhod T.
57 Arcangel, Jaz Lee R.
58 De Guzman, Joebert D.
59 Melendez, Arjay D.
60 Viloria, Bryan M.
61 Zapanta, JP C.
62 Suarez, Cathlen Kaye M.
63 Garcia, Kaizen Lory B.
64 Andal, Princess Sophia L.
65 Ferrer,Ma.Christel B.
66 Lapena, Andrea B.
67 Solomon, Roann D.
68 Tapiador, Lexie Maine D.
69 Castillo, Aldren Jake S.
70 Fernandez, Matteo Del B.
71 Ferrer, Raiven M.
72 Paris, John Lester F.
73 Bautista, Carl Nino P.
74 Macaraeg, Jay D.
75 Gundayao, Reneboy A.
TOTAL: AVERAGE:

D. Actual Feeding

(H ) - Present, served with Hot meals

(M ) - Present, served with Milk
(H/M ) - Present, served with Hot meals & Milk
( A ) - Absent, not served
(H2/M2/(H/M2)) - Present, served twice

page 4
 SBFP Form 3 (2021)

SCHOOL-BASED FEEDING PROGRAM ( MILK )

FOR THE MONTH OF October 11-November 22, 2021, SY 2021-2022

Region : I
Division : San Carlos City, Pangasinan School: Ignacio Centeno Elementary School
District : II-B Grade: Kinder to Grade VI
School ID Number: 102229

ACTUAL FEEDING
ATTENDANCE
NAME OF PUPIL No. of No. of
Days Feeding Percentage
10/11-15/2021 10/18-22/2021 10/25-29/2021 11/2-5/2021 11/8-12/2021 11/15-19/2021 11/22-24/2021 Present Days
5 packs 5 packs 5 packs 5 packs 5 packs 5 packs 3 packs (A) (B) (A/B)*100
76 Pidlaoan, Francis RJ R.
77 Cacal, Faith Ruth D.
78 Cruz, Princess Zharmel P.
79 Poquiz, Kei Cee T.
80 Valerio, Ashly R.
81 Poyaoan, Gabriel Zachea S.
82 Baluyot,Abegail de Guzman
83 Mendoza, Joanna A.
84 Poyaoan,Rham Jay M.
85 De Guzman, Raiver Dylan D.
86 De Guzman, Alexus Jhon
87 Bagbago, Floren C
88 Obispo, Noriz Myka R.
89 Pacundo, Jhansen S.
90 Paris, Julia Althea F.
91 Aranan, Princess Gwen E.
92 Bataan, Princess Jennifer C.
93 Ferrer, Charmaine B.
94 Pimentel, Alexis Mae
95 Poquiz, Jovelyn J.
96 De Guzman,Maria Sabina A
97 Ferrer, Frency Mae F.
98 Abalos,Catherine
99 Reyes, Neko C.
100 Perreras, Darwin V.
TOTAL: AVERAGE:

D. Actual Feeding

(H ) - Present, served with Hot meals

(M ) - Present, served with Milk
(H/M ) - Present, served with Hot meals & Milk
( A ) - Absent, not served
(H2/M2/(H/M2)) - Present, served twice

page 4
 SBFP Form 3 (2021)

SCHOOL-BASED FEEDING PROGRAM ( MILK )

FOR THE MONTH OF October 11-November 22, 2021, SY 2021-2022

Region : I
Division : San Carlos City, Pangasinan School: Ignacio Centeno Elementary School
District : II-B Grade: Kinder to Grade VI
School ID Number: 102229

ACTUAL FEEDING
ATTENDANCE
NAME OF PUPIL No. of No. of
Days Feeding Percentage
10/11-15/2021 10/18-22/2021 10/25-29/2021 11/2-5/2021 11/8-12/2021 11/15-19/2021 11/22-24/2021 Present Days
5 packs 5 packs 5 packs 5 packs 5 packs 5 packs 3 packs (A) (B) (A/B)*100
101` Ferrer, Jhiane Karl M.
102 Aquino, Mark Florence C.
103 Bartolo, Cleaf Kean G.
104 Los Banos , Joshua T.
105 Yee, Nathan C.
106 Bulatao, Jhon Raven P.
107 Melendez, Gerald D.
108 Reyes, Sanjoe F.
109 Andal, Kate Nicole L.
110 Echaque,Nikka J.
111 De Guzman, Mekayella R.
112 Mendoza,KeithCassandraD.
113 Sabangan, Richelle L.
114 Gundayao, Jasmin Mae C.
115 Cayago, Renz B.
116 Ramir, Kevin Daniel P.
117 Bautista, Rheino Martin P.
118 De Guzman, Rain Neil V.
119 De Guzman, Renz Gerald C.
120 Mercado, Justine F.
121 Peralta, Christian F.
122 Sabangan, Rhea Mae
123 Cariaga, Cris Allen S.
124 Melendez, Allysa Gae G.
125 De Guzman, Gelo A.
TOTAL: AVERAGE:

D. Actual Feeding

(H ) - Present, served with Hot meals

(M ) - Present, served with Milk
(H/M ) - Present, served with Hot meals & Milk
( A ) - Absent, not served
(H2/M2/(H/M2)) - Present, served twice

page 4
 SBFP Form 3 (2021)

SCHOOL-BASED FEEDING PROGRAM ( MILK )

FOR THE MONTH OF October 11-November 22, 2021, SY 2021-2022

Region : I
Division : San Carlos City, Pangasinan School: Ignacio Centeno Elementary School
District : II-B Grade: Kinder to Grade VI
School ID Number: 102229

ACTUAL FEEDING
ATTENDANCE
NAME OF PUPIL No. of No. of
Days Feeding Percentage
10/11-15/2021 10/18-22/2021 10/25-29/2021 11/2-5/2021 11/8-12/2021 11/15-19/2021 11/22-24/2021 Present Days
5 packs 5 packs 5 packs 5 packs 5 packs 5 packs 3 packs (A) (B) (A/B)*100
126 Collado, John Mark M.
127 Lapena, Mart Justine C.
128 Mendoza, Josh Kenneth C.
129 Poquiz, Denmark J.
130 De Guzman, Paul Jean L.
131 Mendoza, Shezel V.
132 Boquiren, Marion M.
133 Castaneda, Eddie Boy R.
134 De Guzman, Jericho D.
135 Cabuang, John Christian P.
136 Mendoza,Vance Althea S.
137 De vera, Aica Mae C.

TOTAL: AVERAGE:

D. Actual Feeding

(H ) - Present, served with Hot meals

(M ) - Present, served with Milk
(H/M ) - Present, served with Hot meals & Milk
( A ) - Absent, not served
(H2/M2/(H/M2)) - Present, served twice

page 4
C
Department of Education
Region _I__

Master List Beneficiaries for School-Based Feeding Program (SBFP) (SY 2021-2022)

Division/Province: San Carlos City/ Pangasinan Name of Principal : Camilo P. Bulatao

City/ Municipality/Barangay : San Carlos City/ Cobol Name of Feeding Focal Person : Julieta P. Mondares
Name of School / School District : Ignacio Centeno Elementary School/District II-B
School ID Number: 102229

Nutritional Parent's
BMI for
Grade/ Date of Weighing / Age in Weight Height 6 y.o. Status (NS) Dewormed? consent for
Date of Birth
No. Name Sex Section (MM/DD/YYYY)
Measuring Years / milk?
(MM/DD/YYYY) Months (Kg) (cm) and (yes or no) (yes or
above
no)
BMI-A HFA
105 Yee, Nathan C. M Gr.III 2/21/2013 yes
106 Bulatao, Jhon Raven P. M Gr.III 4/28/2013 yes
107 Melendez, Gerald D. M Gr.III 2/19/2013 yes
108 Reyes, Sanjoe F. M Gr.III 1/2/2013 yes
109 Andal, Kate Nicole L. F Gr.III 12/29/2011 yes
110 Echaque,Nikka J. F Gr.III 4/6/2013 yes
111 De Guzman, Mekayella R. F Gr.III 9/4/2012 yes
112 Mendoza,KeithCassandraD. F Gr.III 9/2/2012 yes
113 Sabangan, Richelle L. F Gr.III 9/22/2013 yes
114 Gundayao, Jasmin Mae C. F Gr.III 1/15/2013 yes
115 Cayago, Renz B. M Gr.IV 9/21/2011 yes
116 Ramir, Kevin Daniel P. M Gr.IV 1/24/2012 yes
117 Bautista, Rheino Martin P. M Gr.IV 1/9/2012 yes
Prepared by: Approved by:
 CAMILO P. BULATAO
JULIETA P. MONDARES School Head
Feeding Focal Person

Note: This form shall be prepared by the school before the start of feeding to be compiled by the SDO.
Keep columns 6-12 blank if nutritional assesment is still suspended.
 Participation Beneficiary of
in 4Ps SBFP in
(yes or no) Previous Years
(yes or no)

no yes
no yes
no yes
no yes
no yes
yes yes
yes yes
no yes
no yes
no yes
no yes
no yes
no yes
C
Department of Education
Region _I__

Master List Beneficiaries for School-Based Feeding Program (SBFP) (SY 2021-2022)

Division/Province: San Carlos City/ Pangasinan Name of Principal : Camilo P. Bulatao

City/ Municipality/Barangay : San Carlos City/ Cobol Name of Feeding Focal Person : Julieta P. Mondares
Name of School / School District : Ignacio Centeno Elementary School/District II-B
School ID Number: 102229

Nutritional Parent's
BMI for
Grade/ Date of Weighing / Age in Weight Height 6 y.o. Status (NS) Dewormed? consent for
Date of Birth
No. Name Sex Section (MM/DD/YYYY)
Measuring Years / milk?
(MM/DD/YYYY) Months (Kg) (cm) and (yes or no) (yes or
above
no)
BMI-A HFA
118 De Guzman, Rain Neil V. M Gr.IV 7/8/2011 yes
119 De Guzman, Renz Gerald C. M Gr.IV 7/11/2011 yes
120 Mercado, Justine F. M Gr.IV 9/19/2011 yes
121 Peralta, Christian F. M Gr.IV 9/6/2011 yes
122 Sabangan, Rhea Mae F Gr.IV 3/7/2012 yes
123 Cariaga, Cris Allen S. F Gr.IV 11/12/2011 yes
124 Melendez, Allysa Gae G. F Gr.IV 12/13/2011 yes
125 De Guzman, Gelo A. M Gr.V 5/19/2011 yes
126 Collado, John Mark M. M Gr.V 11/15/2010 yes
127 Lapena, Mart Justine C. M Gr.V 9/22/2010 yes
128 Mendoza, Josh Kenneth C. M Gr.V 4/13/2011 yes
129 Poquiz, Denmark J. M Gr.V 2/5/2011 yes
130 De Guzman, Paul Jean L. M Gr.V 12/23/2010 yes
Prepared by: Approved by:
 CAMILO P. BULATAO
JULIETA P. MONDARES School Head
Feeding Focal Person

Note: This form shall be prepared by the school before the start of feeding to be compiled by the SDO.
Keep columns 6-12 blank if nutritional assesment is still suspended.
 Participation Beneficiary of
in 4Ps SBFP in
(yes or no) Previous Years
(yes or no)

no yes
no yes
no yes
no yes
yes yes
yes yes
no yes
no yes
no yes
no yes
no yes
no yes
no yes
C
Department of Education
Region _I__

Master List Beneficiaries for School-Based Feeding Program (SBFP) (SY 2021-2022)

Division/Province: San Carlos City/ Pangasinan Name of Principal : Camilo P. Bulatao

City/ Municipality/Barangay : San Carlos City/ Cobol Name of Feeding Focal Person : Julieta P. Mondares
Name of School / School District : Ignacio Centeno Elementary School/District II-B
School ID Number: 102229

Nutritional Parent's
BMI for
Grade/ Date of Weighing / Age in Weight Height 6 y.o. Status (NS) Dewormed? consent for
Date of Birth
No. Name Sex Section (MM/DD/YYYY)
Measuring Years / milk?
(MM/DD/YYYY) Months (Kg) (cm) and (yes or no) (yes or
above
no)
BMI-A HFA
92 Bataan, Princess Jennifer C. F Gr.II 9/1/2013 yes
93 Ferrer, Charmaine B. F Gr.II 10/4/2013 yes
94 Pimentel, Alexis Mae F Gr.II 10/2/2013 yes
95 Poquiz, Jovelyn J. F Gr.II 3/6/2014 yes
96 De Guzman,Maria Sabina A F Gr.II 8/25/2014 yes
97 Ferrer, Frency Mae F. F Gr.II 10/20/2014 yes
98 Abalos,Catherine F Gr.II 10/21/2014 yes
99 Reyes, Neko C. M Gr.III 11/16/2012 yes
100 Perreras, Darwin V. M Gr.III 2/16/2012 yes
101 Ferrer, Jhiane Karl M. M Gr.III 10/22/2012 yes
102 Aquino, Mark Florence C. M Gr.III 3/8/2011 yes
103 Bartolo, Cleaf Kean G. M Gr.III 10/20/2012 yes
104 Los Banos , Joshua T. M Gr.III 10/21/2012 yes
Prepared by: Approved by:
 CAMILO P. BULATAO
JULIETA P. MONDARES School Head
Feeding Focal Person

Note: This form shall be prepared by the school before the start of feeding to be compiled by the SDO.
Keep columns 6-12 blank if nutritional assesment is still suspended.
 Participation Beneficiary of
in 4Ps SBFP in
(yes or no) Previous Years
(yes or no)

no yes
no yes
no yes
no yes
no yes
no yes
no yes
no yes
no yes
no yes
no yes
no yes
no yes
C
Department of Education
Region _I__

Master List Beneficiaries for School-Based Feeding Program (SBFP) (SY 2021-2022)

Division/Province: San Carlos City/ Pangasinan Name of Principal : Camilo P. Bulatao

City/ Municipality/Barangay : San Carlos City/ Cobol Name of Feeding Focal Person : Julieta P. Mondares
Name of School / School District : Ignacio Centeno Elementary School/District II-B
School ID Number: 102229

Nutritional Parent's
BMI for
Grade/ Date of Weighing / Age in Weight Height 6 y.o. Status (NS) Dewormed? consent for
Date of Birth
No. Name Sex Section (MM/DD/YYYY)
Measuring Years / milk?
(MM/DD/YYYY) Months (Kg) (cm) and (yes or no) (yes or
above
no)
BMI-A HFA
79 Poquiz, Kei Cee T. F Gr.I 9/18/2014 yes
80 Valerio, Ashly R. F Gr.I 1/6/2015 yes
81 Poyaoan, Gabriel Zachea S. F Gr.I 12/14/2014 yes
82 Baluyot,Abegail de Guzman F Gr.I 5/1/2015 yes
83 Mendoza, Joanna A. F Gr.I 11/22/2014 yes
84 Poyaoan,Rham Jay M. M Gr.II 7/14/2014 yes
85 De Guzman, Raiver Dylan D. M Gr.II 9/10/2013 yes
86 De Guzman, Alexus Jhon M Gr.II 1/4/2014 yes
87 Bagbago, Floren C M Gr.II 12/22/2013 yes
88 Obispo, Noriz Myka R. F Gr.II 11/8/2013 yes
89 Pacundo, Jhansen S. F Gr.II 12/2/2013 yes
90 Paris, Julia Althea F. F Gr.II 12/8/2013 yes
91 Aranan, Princess Gwen E. F Gr.II 1/23/2013 yes
Prepared by: Approved by:
 CAMILO P. BULATAO
JULIETA P. MONDARES School Head
Feeding Focal Person

Note: This form shall be prepared by the school before the start of feeding to be compiled by the SDO.
Keep columns 6-12 blank if nutritional assesment is still suspended.
 Participation Beneficiary of
in 4Ps SBFP in
(yes or no) Previous Years
(yes or no)

no yes
no yes
no yes
no yes
no yes
no yes
no yes
no yes
no yes
no yes
no yes
no yes
yes yes
C
Department of Education
Region _I__

Master List Beneficiaries for School-Based Feeding Program (SBFP) (SY 2021-2022)

Division/Province: San Carlos City/ Pangasinan Name of Principal : Camilo P. Bulatao

City/ Municipality/Barangay : San Carlos City/ Cobol Name of Feeding Focal Person : Julieta P. Mondares
Name of School / School District : Ignacio Centeno Elementary School/District II-B
School ID Number: 102229

Nutritional Parent's
BMI for
Grade/ Date of Weighing / Age in Weight Height 6 y.o. Status (NS) Dewormed? consent for
Date of Birth
No. Name Sex Section (MM/DD/YYYY)
Measuring Years / milk?
(MM/DD/YYYY) Months (Kg) (cm) and (yes or no) (yes or
above
no)
BMI-A HFA
66 Lapena, Andrea B. F Gr.I 1/7/2015 yes
67 Solomon, Roann D. F Gr.I 3/26/2015 yes
68 Tapiador, Lexie Maine D. F Gr.I 10/3/2015 yes
69 Castillo, Aldren Jake S. M Gr.I 10/31/2014 yes
70 Fernandez, Matteo Del B. M Gr.I 4/3/2014 yes
71 Ferrer, Raiven M. M Gr.I 7/27/2015 yes
72 Paris, John Lester F. M Gr.I 7/6/2015 yes
73 Bautista, Carl Nino P. M Gr.I 10/7/2015 yes
74 Macaraeg, Jay D. M Gr.I 9/1/2014 yes
75 Gundayao, Reneboy A. M Gr.I 3/29/2014 yes
76 Pidlaoan, Francis RJ R. M Gr.I 1/2/2015 yes
77 Cacal, Faith Ruth D. F Gr.I 1/26/2014 yes
78 Cruz, Princess Zharmel P. F Gr.I 10/11/2014 yes
Prepared by: Approved by:
 CAMILO P. BULATAO
JULIETA P. MONDARES School Head
Feeding Focal Person

Note: This form shall be prepared by the school before the start of feeding to be compiled by the SDO.
Keep columns 6-12 blank if nutritional assesment is still suspended.
 Participation Beneficiary of
in 4Ps SBFP in
(yes or no) Previous Years
(yes or no)

no yes
no yes
no yes
no yes
no yes
no yes
no yes
no yes
no yes
no yes
no yes
no yes
no yes
C
Department of Education
Region _I__

Master List Beneficiaries for School-Based Feeding Program (SBFP) (SY 2021-2022)

Division/Province: San Carlos City/ Pangasinan Name of Principal : Camilo P. Bulatao

City/ Municipality/Barangay : San Carlos City/ Cobol Name of Feeding Focal Person : Julieta P. Mondares
Name of School / School District : Ignacio Centeno Elementary School/District II-B
School ID Number: 102229

Nutritional Parent's
BMI for
Grade/ Date of Weighing / Age in Weight Height 6 y.o. Status (NS) Dewormed? consent for
Date of Birth
No. Name Sex Section (MM/DD/YYYY)
Measuring Years / milk?
(MM/DD/YYYY) Months (Kg) (cm) and (yes or no) (yes or
above
no)
BMI-A HFA
53 Doria, Jenny F. F Kinder 10/27/2016 yes
54 Repato,Mark Rhenz P. M Gr.I 11/24/2014 yes
55 Tibay, Gabriel C. M Gr.I 1/30/2015 yes
56 De Vera, John Rhod T. M Gr.I 9/23/2015 yes
57 Arcangel, Jaz Lee R. M Gr.I 2/12/2015 yes
58 De Guzman, Joebert D. M Gr.I 12/4/2014 yes
59 Melendez, Arjay D. M Gr.I 11/15/2014 yes
60 Viloria, Bryan M. M Gr.I 10/14/2014 yes
61 Zapanta, JP C. M Gr.I 9/16/2015 yes
62 Suarez, Cathlen Kaye M. F Gr.I 4/17/2014 yes
63 Garcia, Kaizen Lory B. F Gr.I 4/18/2015 yes
64 Andal, Princess Sophia L. F Gr.I 9/10/2014 yes
65 Ferrer,Ma.Christel B. F Gr.I 8/19/2015 yes
Prepared by: Approved by:
 CAMILO P. BULATAO
JULIETA P. MONDARES School Head
Feeding Focal Person

Note: This form shall be prepared by the school before the start of feeding to be compiled by the SDO.
Keep columns 6-12 blank if nutritional assesment is still suspended.
 Participation Beneficiary of
in 4Ps SBFP in
(yes or no) Previous Years
(yes or no)

no no
yes no
no no
no no
no yes
no yes
no yes
yes yes
no yes
no yes
no no
no yes
no yes
C
Department of Education
Region _I__

Master List Beneficiaries for School-Based Feeding Program (SBFP) (SY 2021-2022)

Division/Province: San Carlos City/ Pangasinan Name of Principal : Camilo P. Bulatao

City/ Municipality/Barangay : San Carlos City/ Cobol Name of Feeding Focal Person : Julieta P. Mondares
Name of School / School District : Ignacio Centeno Elementary School/District II-B
School ID Number: 102229

Nutritional Parent's
BMI for
Grade/ Date of Weighing / Age in Weight Height 6 y.o. Status (NS) Dewormed? consent for
Date of Birth
No. Name Sex Section (MM/DD/YYYY)
Measuring Years / milk?
(MM/DD/YYYY) Months (Kg) (cm) and (yes or no) (yes or
above
no)
BMI-A HFA
40 Aquino,Liza C. F Kinder 11/16/2015 yes
41 Aquino,Sarah O. F Kinder 4/14/2016 yes
42 Cabral, Colleen Elizabeth D. F Kinder 5/9/2016 yes
43 De Guzman, Mariebeth D. F Kinder 4/24/2016 yes
44 Dolor, Khate Sofia D. F kinder 8/24/2016 yes
45 Garcillian,Kyrie Yen S. F Kinder 1/27/2016 yes
46 Gundayao, Reanna Marie M. F Kinder 5/15/2016 yes
47 Layno,Leiziah O. F Kinder 2/29/2016 yes
48 Luciano, Margaux D. F Kinder 12/1/2015 yes
49 Solomon,Khandra Maine R. F Kinder 3/15/2016 yes
50 Solomon,Venice Hayley T. F Kinder 10/28/2015 yes
51 Torres,Khaela Jannah S. F Kinder 7/27/2016 yes
52 Zapanta,Janine D. F Kinder 1/2/2011 yes
Prepared by: Approved by:
 CAMILO P. BULATAO
JULIETA P. MONDARES School Head
Feeding Focal Person

Note: This form shall be prepared by the school before the start of feeding to be compiled by the SDO.
Keep columns 6-12 blank if nutritional assesment is still suspended.
 Participation Beneficiary of
in 4Ps SBFP in
(yes or no) Previous Years
(yes or no)

no no
no no
no no
no no
no no
no no
no no
no no
no no
no no
no no
no no
no no
C
Department of Education
Region _I__

Master List Beneficiaries for School-Based Feeding Program (SBFP) (SY 2021-2022)

Division/Province: San Carlos City/ Pangasinan Name of Principal : Camilo P. Bulatao

City/ Municipality/Barangay : San Carlos City/ Cobol Name of Feeding Focal Person : Julieta P. Mondares
Name of School / School District : Ignacio Centeno Elementary School/District II-B
School ID Number: 102229

Nutritional Parent's
BMI for
Grade/ Date of Weighing / Age in Weight Height 6 y.o. Status (NS) Dewormed? consent for
Date of Birth
No. Name Sex Section (MM/DD/YYYY)
Measuring Years / milk?
(MM/DD/YYYY) Months (Kg) (cm) and (yes or no) (yes or
above
no)
BMI-A HFA
27 Tan, Josie Ann F Kinder 10/1/2014 yes
28 Ancheta, Kenshin Jade M kinder 8/2/2016 yes
29 Boquiren, Kyle Estephen L. M Kinder 6/19/2016 yes
30 Junio, Caleb Josh D. M Kinder 12/12/2015 yes
31 Ferrer, Jay-Dee T. M Kinder 2/5/2016 yes
32 Ferrer, Khris Derick L. M Kinder 1/12/2016 yes
33 Mendoza, Harold S. M Kinder 2/21/2016 yes
34 Mendoza,Ralph Vander T. M Kinder 10/20/2015 yes
35 Mendoza, Xynon Arceus C. M Kinder 7/12/2016 yes
36 Gundayao, Chadric Josh T. M Kinder 2/1/2016 yes
37 Reyes, Din Cyrus F. M Kinder 8/13/2016 yes
38 Canta, Jomar D. M Kinder 8/24/2016 yes
39 Ancheta,Xiamara Annika A. F Kinder 9/26/2015 yes
Prepared by: Approved by:
 CAMILO P. BULATAO
JULIETA P. MONDARES School Head
Feeding Focal Person

Note: This form shall be prepared by the school before the start of feeding to be compiled by the SDO.
Keep columns 6-12 blank if nutritional assesment is still suspended.
 Participation Beneficiary of
in 4Ps SBFP in
(yes or no) Previous Years
(yes or no)

no no
no no
no no
no no
no no
no no
no no
no no
no no
no no
no no
no no
no no
C
Department of Education
Region _I__

Master List Beneficiaries for School-Based Feeding Program (SBFP) (SY 2021-2022)

Division/Province: San Carlos City/ Pangasinan Name of Principal : Camilo P. Bulatao

City/ Municipality/Barangay : San Carlos City/ Cobol Name of Feeding Focal Person : Julieta P. Mondares
Name of School / School District : Ignacio Centeno Elementary School/District II-B
School ID Number: 102229

Nutritional Parent's
BMI for
Grade/ Date of Weighing / Age in Weight Height 6 y.o. Status (NS) Dewormed? consent for
Date of Birth
No. Name Sex Section (MM/DD/YYYY)
Measuring Years / milk?
(MM/DD/YYYY) Months (Kg) (cm) and (yes or no) (yes or
above
no)
BMI-A HFA
14 Reyes,Matt Ezekiel C. M Kinder 8/10/2016 yes
15 Salting,John Noel A. M Kinder 1/25/2016 yes
16 Santos,Jovinson F. M Kinder 6/19/2016 yes
17 Ferrer, Jacky N. M Kinder 7/18/2016 yes
18 Bulatao, Abegail F Kinder 8/13/2016 yes
19 Samberi, Mae M. F Kinder 10/9/2015 yes
20 Lagunday, Kassandra F Kinder 12/13/2015 yes
21 Austria, Pia Maine M. F Kinder 2/28/2016 yes
22 Vergara, Sofia Kate C. F Kinder 11/3/2015 yes
23 Ducusin, Aishanelle M. F Kinder 10/7/2016 yes
24 Audije,Maeganne Erin C. F Kinder 5/23/2015 yes
25 Austria,Axel Shin M. F Kinder 9/23/2016 yes
26 Seguisa, Ma. Paulene F Kinder 6/3/2016 yes
Prepared by: Approved by:
 CAMILO P. BULATAO
JULIETA P. MONDARES School Head
Feeding Focal Person

Note: This form shall be prepared by the school before the start of feeding to be compiled by the SDO.
Keep columns 6-12 blank if nutritional assesment is still suspended.
 Participation Beneficiary of
in 4Ps SBFP in
(yes or no) Previous Years
(yes or no)

no no
yes no
no no
no no
no no
yes no
no no
no no
no no
yes no
no no
no no
no no
SBFP Form 2 (2021)
Department of Education
Region I

SCHOOL-BASED FEEDING PROGRAM (SBFP) SUMMARY OF BENEFICIARIES & START OF FEEDING (SY 2021-2022)
Division/Province: San Carlos City, Pangasinan
City/ Municipality/Barangay : San Carlos City/ Cobol
Name of School / School District : Ignacio Centeno Elementary School/ II-B
School ID Number: 102229
Date of Start of Feeding: __________________________
Last Mile School: ___Y ___N
Nutritional Status at Start/End of Feeding No. of Secondary Targets No. of 4 No. of 4 Ps No. of Pupils Date Feeding
Learners Beneficiaries who are Started/Ended
SW W N OW+O SS S N T No. of Pupils- No. of No. of No. of Dewormed beneficiaries in
Number of Undernourished School at-risk-of- Stunted/ Indigent Indigenous previous years
Children by Grade Level dropping-out Severely Learners Peoples (IPs) (Repeaters)
(PARDOs) Stunted

1. Kinder 56 6 0

2. Grade I 30 2 26

3. Grade II 15 2 15

4. Grade III 16 2 16

5. Grade IV 10 2 10

6. Grade V 7 0 7

7. Grade VI 3 3 3

Total 137 15 77

Prepared by: Approved by:

JULIETA P. MONDARES CAMILO P. BULATAO

SBFP DepEd Focal School Head

Note: This form shall be prepared by the school before the start of feeding and after feeding, to be compiled by the SDO, and for final compilation by the RO, for submission to DepEd BLSS-SHD
C
Department of Education
Region _I__

Master List Beneficiaries for School-Based Feeding Program (SBFP) (SY 2021-2022)

Division/Province: San Carlos City/ Pangasinan Name of Principal : Camilo P. Bulatao

City/ Municipality/Barangay : San Carlos City/ Cobol Name of Feeding Focal Person : Julieta P. Mondares
Name of School / School District : Ignacio Centeno Elementary School/District II-B
School ID Number: 102229

Nutritional Parent's
BMI for
Grade/ Date of Weighing / Age in Weight Height 6 y.o. Status (NS) Dewormed? consent for
Date of Birth
No. Name Sex Section (MM/DD/YYYY)
Measuring Years / milk?
(MM/DD/YYYY) Months (Kg) (cm) and (yes or no) (yes or
above
no)
BMI-A HFA
1 Estacio,Arjohn V. M Kinder 9/22/2015 yes
2 Neri,Brix V. M Kinder 7/19/2016 yes
3 Sumera,Allan D. M Kinder 6/8/2016 yes
4 Ferrer,Rangie S. M Kinder 3/24/2016 yes
5 Samberi,Jim F. M Kinder 10/23/2013 yes
6 Valdez,Justin Clark P. M Kinder 9/4/2016 yes
7 De Santos,Mark Jian P. M Kinder 10/4/2015 yes
8 Ancheta,Muhammad Ahmed M Kinder 10/12/2015 yes
9 Criste, Gerald Xander Y. M Kinder 4/18/2016 yes
10 Dellova, Ezekel L. M Kinder 10/5/2016 yes
11 Domantay,Martin Jr. Z. M Kinder 12/24/2015 yes
12 Ferrer,Jhonel B. M Kinder 6/13/2016 yes
13 Ramos, Sean D. M Kinder 9/13/2016 yes
Prepared by: Approved by:
 CAMILO P. BULATAO
JULIETA P. MONDARES School Head
Feeding Focal Person

Note: This form shall be prepared by the school before the start of feeding to be compiled by the SDO.
Keep columns 6-12 blank if nutritional assesment is still suspended.
 Participation Beneficiary of
in 4Ps SBFP in
(yes or no) Previous Years
(yes or no)

no no
no no
no no
no no
yes no
no no
no no
no no
no no
no no
yes no
no no
yes no
SBFP Form 5 (2020)

DEPARTMENT OF EDUCATION
Region __I__

REGION/DIVISION/DISTRICT: _I / San Carlos City_/ II-B

NAME OF SCHOOL: Ignacio Centeno Elementary School
SCHOOL ID NO.: _102229___________________________________________________________________

SCHOOL-BASED FEEDING PROGRAM - MILK COMPONENT

LIST OF AUTHORIZED CONSIGNEES ( SY 2021-2022 )

NAME & DESIGNATION TEL. NO. MOBILE NO. EMAIL ADD SPECIMEN
SIGNATURE
1 (School Head)
Camilo P. Bulatao 9456507747 camilo.bulatao001@
r1deped.gov.ph
2 (School Feeding Coordinator)
Julieta P. Mondares 9150465332 julieta.mondares@
deped.gov.ph
3 (School Property Custodian)
Jovita A. De Guzman 9166985854 jovita.deguzman002@
deped.gov.ph

SCHOOL INSPECTION TEAM (SY 2021-2022)

NAME & DESIGNATION TEL. NO. MOBILE NO. EMAIL ADD SPECIMEN
SIGNATURE
1 Agnes R. Roxas
9063583970 agnes.roxas005@
deped.gov.ph
2 Filipina M. Ramirez
9204125169 filipina.ramirez@
deped.gov.ph
3 Independencia Y. Ramos
9309422464 maindependencia.
ramos@deped.gov.ph
SBFP Form 5 (2020)

Note: Only authorized consignees are allowed to receive the goods.

SBFP Form 5 (2021)

DEPARTMENT OF EDUCATION
Region I

REGION/DIVISION/DISTRICT: I / SAN CARLOS CITY, PANGASINAN /II-B

NAME OF SCHOOL: IGNACIO CENTENO ELEMENTARY SCHOOL
SCHOOL ID NO.: 102229

SCHOOL-BASED FEEDING PROGRAM - MILK COMPONENT

LIST OF BENEFICIARIES (SY2021-2022)

Classification of Students in terms of Milk Tolerance
(Please check one)
Without milk With milk Not allowed by
intolerance and will intolerance but parents to
Name Grade & Section participate in milk willing to participate in milk
feeding participate in milk feeding
feeding
SBFP Form 5 (2021)

Prepared by: APPROVED BY:

JULIETA P. MONDARES CAMILO P. BULATAO

School Feeding Coordinator School Head
SBFP Form 6 (2021)

DEPARTMENT OF EDUCATION
Region _I__

REGION/DIVISION/DISTRICT: I/San Carlos City Pangasinan/II-B

NAME OF SCHOOL: Ignacio Centeno Elementary School
SCHOOL ID NO.: 102229

SCHOOL-BASED FEEDING PROGRAM

NFP DELIVERIES (SY 2021-2022)

Grade Level Number of Beneficiaries Date No. of Packs Received No. of Packs for Remarks
Delivered Replacement/
New Replacement Total (New + Rejected
Replacement)
Kinder 56
Grade 1 30
Grade 2 15
Grade 3 16
Grade 4 10
Grade 5 7
Grade 6 3
TOTAL: 137

MILK DELIVERIES (SY 2021-2022 )

Grade Level Number of Beneficiaries Date No. of Packs Received No. of Packs for Remarks
Delivered Replacement/
New Replacement Total (New + Rejected
Replacement)
Kinder 56
Grade 1 30
Grade 2 15
Grade 3 16
Grade 4 10
Grade 5 7
Grade 6 3
TOTAL: 137
SBFP Form 6 (2021)

Prepared by: APPROVED BY:

JULIETA P. MONDARES CAMILO P. BULATAO

School Feeding Coordinator School Head