SBFP Form 1 (2020)

Department of Education
Region I

Master List Beneficiaries for School-Based Feeding Program (SBFP) (SY 2020-21 )

Division/Province: ___________________ ILOCOS SUR Name of Principal : ____ JOSELITO U. URMENETA

City/ Municipality/Barangay : ___________ MAGSINGAL Name of Feeding Focal Person : _________ GETRUDIS BENEDICTA T. UNCIANO
Name of School / School District : ______ PATONG ELEMENTARY SCHOOL
School ID Number: ________________________ 100510
BMI for Nutritional Status Parent's
Date of Weighing / Age in 6 y.o. Dewormed? consent for Participation in
No. Name Sex Grade/ Date of Birth Measuring Years / Weight Height (NS) (yes 4Ps
Section (MM/DD/YYYY) (Kg) (cm) and BMI-A HFA milk?
(MM/DD/YYYY) Months above or no) (yes or no) (yes or no)
1 AMISTAD, JAYCIE PRIEL R. M KINDER 06/28/2016 5/4/2022 5-9 20 110 Normal Normal NO YES NO
2 AN, JIAN MAVERICK U. M KINDER 10/31/2016 5/4/2022 5-5 20 115 Normal Normal NO YES NO
3 BANIAGA, MIKE ACE V. M KINDER 4/5/2016 5/4/2022 5-9 17 107 Normal Normal NO YES NO
4 BATTAD, DWAYNE KYZER T. M KINDER 5/6/2016 5/4/2022 5-8 17 109 Normal Normal NO YES YES
5 BATTAD, RAE MATEUS U. M KINDER 5/12/2015 5/4/2022 6-4 16 106 14.2 Normal Stunted NO YES NO
6 CARTA,CILLIAN INIGO S. M KINDER 09/29/2016 5/4/2022 5-5 18 111 Normal Normal NO YES YES
7 CASAGUEP, MARJUN C. M KINDER 10/22/2016 5/4/2022 5-5 23 111 Normal Normal NO YES NO
8 FELIX, GABRIELLE C. M KINDER 1/3/2016 5/4/2022 6-1 17 110 14 Normal Normal NO YES NO
9 MARANON, XAVIER A. M KINDER 11/10/2016 5/4/2022 5-4 17 105 Normal Normal NO YES YES
10 ORIS, MAY B. M KINDER 4/9/2016 5/4/2022 5-5 18 105 Normal Normal NO YES YES
11 POLA, PRINCE AIVAN U. M GRADE I 11/5/2015 5/4/2022 6-10 15 121 13.6 Normal Severely St NO YES YES
12 TABUAN, ARWIND JORDAN L. M KINDER 01/17/2016 5/4/2022 6-2 16 112 14.5 Normal Normal NO YES NO
13 TARANGCO, ANGELO G. M KINDER 7/11/2015 5/4/2022 6-4 25 113 13.6 Normal Normal NO YES YES
Prepared by: Approved by:

GETRUDIS BENEDICTA T. UNCIANO JOSELITO U. URMENETA

__________________________________
Feeding Focal Person

Note: This form shall be prepared by the school before the start of feeding to be compiled by the SDO.
 Beneficiary of
SBFP in Previous
Years (yes or no)
NO
NO
NO
NO
NO
NO
NO
NO
NO
NO
YES
NO
NO
SBFP Form 1 (2020)
Department of Education
Region I

Master List Beneficiaries for School-Based Feeding Program (SBFP) (SY 2021-22 )

Division/Province: ____________________ ILOCOS SUR Name of Principal : ____ JOSELITO U. URMENE

City/ Municipality/Barangay : ___________ MAGSINGAL Name of Feeding Focal Person : _________
Name of School / School District : ______ PATONG ELEMENTARY SCHOOL
School ID Number: _________________________ 100510
BMI for
Grade/ Date of Birth Date of Weighing / Age in Weight Height 6 y.o.
No. Name Sex Measuring Years /
Section (MM/DD/YYYY) (Kg) (cm) and
(MM/DD/YYYY) Months above
14 TARANGCO, JETT KEAN B. M KINDER 01/25/2016 5/4/2022 6-2 112 112 15.9
15 TICA,JOHN MEL A. M KINDER 09/13/2016 5/4/2022 5-5 113 113
16 UBILAS, ELDRIC P. M GRADE I 08/13/2015 5/4/2022 6-7 120 120 12.5
17 ULLERO, AKIRO KENJIE T. M KINDER 09/13/2016 5/4/2022 5-5 112 112
18 URSUA, ANGELO GABRIEL U. M KINDER 06/19/2016 5/4/2022 5-7 113 113
19 BATTAD, MYRTEL JOY S. F KINDER 07/15/2016 5/4/2022 5-6 107 107
20 CHUMAWIN, AIRA JEAN U. F KINDER 01/25/2016 5/4/2022 6-2 107 107 16.5
21 LIBERATO, JANELLA M. F GRADE I 5/9/2015 5/4/2022 6-7 113 113 11.7
22 POLA, MAINE ASHLEY U. F KINDER 01/23/2016 5/4/2022 6-2 109 109 13.4
23 PULLER, XHEIRA NICOLE T. F KINDER 09/22/2016 5/4/2022 5-5 99 99
24 ROSARIO, TIFFANY MILES G. F KINDER 04/15/2016 5/4/2022 5-9 111 111
25 SARMIENTO, JILLIIANE P. F KINDER 01/25/2016 5/4/2022 5-1 114 111
26 TICA, JERALYN T. F KINDER 7/1/2016 5/4/2022 6-Feb 105 116 18.1
Prepared by: Approved by:

GETRUDIS BENEDICTA T. UNCIANO JOSELITO U. URMENETA

__________________________________ 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.
m (SBFP) (SY 2021-22 )

JOSELITO U. URMENETA
al Person : _________ GETRUDIS BENEDICTA T. UNCIANO

Nutritional Status Parent's

Dewormed? consent for Participation in Beneficiary of
(NS) (yes 4Ps SBFP in Previous
BMI-A HFA milk?
or no) (yes or no) (yes or no) Years (yes or no)
Normal Normal NO YES NO NO
Normal Normal NO YES NO NO
Wasted Normal NO YES YES YES
Normal Normal NO YES NO NO
Wasted Normal NO YES NO NO
Normal Normal NO YES NO NO
Normal Normal NO YES YES NO
Wasted Normal NO YES NO YES
Normal Normal NO YES YES NO
Normal Stunted NO YES NO NO
Normal Normal NO YES YES NO
Normal Normal NO YES YES NO
Normal Normal NO YES NO NO

SELITO U. URMENETA
School Head
SBFP Form 1 (2020)
Department of Education
Region I

Master List Beneficiaries for School-Based Feeding Program (SBFP) (SY 2020-21 )

Division/Province: ____________________ ILOCOS SUR Name of Principal : ____ JOSELITO U. URMENE

City/ Municipality/Barangay : ___________ MAGSINGAL Name of Feeding Focal Person : _________
Name of School / School District : ______ PATONG ELEMENTARY SCHOOL
School ID Number: _________________________ 100510
BMI for
Grade/ Date of Birth Date of Weighing / Age in Weight Height 6 y.o.
No. Name Sex Measuring Years /
Section (MM/DD/YYYY) (Kg) (cm) and
(MM/DD/YYYY) Months above
27 TORRENO, MOIRA JANELLA E. F GRADE I 11/5/2015 5/4/2022 6-10 15 116 12.6
28 UNANA, RANGEAH HELEINA T. F KINDER 02/24/2016 5/4/2022 6-1 23 118 16.5
29 UNZO, AKESHA FAYE A. F GRADE I 6/9/2015 5/4/2022 6-6 14 111 12
30 URMENETA, JULIE MAY J. F KINDER 08/13/2016 5/4/2022 5-5 14 110
31 USANA, ZHYRINE P. F GRADE I 5/7/2015 5/4/2022 6-Sep 14 110 18.2

Prepared by: Approved by:

GETRUDIS BENEDICTA T. UNCIANO JOSELITO U. URMENETA

__________________________________ 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.
m (SBFP) (SY 2020-21 )

JOSELITO U. URMENETA
al Person : _________ GETRUDIS BENEDICTA T. UNCIANO

Nutritional Status Parent's

Dewormed? consent for Participation in Beneficiary of
(NS) (yes 4Ps SBFP in Previous
BMI-A HFA milk?
or no) (yes or no) (yes or no) Years (yes or no)
WastedNormal NO YES YES YES
Normal Normal NO YES NO NO
Wasted Normal NO YES YES YES
Wasted Normal NO YES YES NO
Wasted Normal NO YES NO YES

SELITO U. URMENETA
School Head