To be accomplished by CDW

and to be submitted to LSWDO/DCO Department of Social Welfare and Development - Field Office VII
10/22/2021

SUPPLEMENTARY FEEDING PROGRAM CYCLE 12 (CY 2022)

MASTERLIST OF BENEFICIARIES
Brgy./City or Municipality/Province MANDAUE CITY
Name of CDC / SNP Group CASILI CHILD DEVELOPMENT CENTER
Name of CDW / SNP Worker GINA T. SUSON
PRIVACY AND CONFIDENTIAL STATEMENT : All personal information provided will be kept strictly confidential and will only be used for official purposes.
Pantawid
Dewor- Vit. A If child is IP/ Ethnic group if
SEX
a PWD
Member
applicable
NUTRITIONAL STATUS (Upon Entry) NUTRITIONAL STATUS (Endline)
ming Supp. (4p's) Date of
BIRTHDATE Date of
NAME OF CHILD Name of Mother/ Household Head Weighing
Pls. put check (/) if applicable (Input date in Weighing (Input
No. (First Name, Middle Initial and Family Name ex: (First Name Middle Initial and FamilyName ex: (Input date in
day/month/ye date in
Maria Ann C. Navarro ) (pls. classify if Shennica Jan V. Tan) day/month/ye
F M F
ar) day/month/year) STUNTING WASTING STUNTING WASTING
M/F (/) (/) M
Aeta, Ita, Bajao,
M F
AGE HEIGHT WEIGHT Weight
(Height for (Weight for
ar) AGE HEIGHT WEIGHT Weight
(Height for (Weight for
Igorot, Moro & (in mos.) (in cm.) (in kilos) for Age (in mos.) (in cm.) (in kilos) for Age
Others) Age) height) Age) height)

1
JOANNAH A. DIMAS 10-6-18 28-07-22 49 100 15
F

2
28-07-22 98 14
F JOCELYN B. INDAC 24-7-18 48

3 28-07-22 96 14.5
F LEYRA O. DOBLON 11-6-18 49

4 28-07-22 105 18
F LEYNARD O. DOBLON 30-3-18 52

5
F 28-07-22 105 17.5
JACQUELINE M. LAURON 8-12-18 43

6
F 28-07-22 99 15
MAYRELL . FERRATER 9-7-18 48

7
F DIENELLE ABREGUNDA 12-2-18 28-07-22 100 14.5
53

8
28-07-22 101 16.5
F AIREEN M. CARSIDO 17-10-18 45

28-07-22 99 14.5
9
F MARY KRIS ICOT 18-1-18 54

10
10-3-18 28-07-22 100 15
F FLORAME LUYAO 52
Total: Total: Total:
Nutritional Status: (Weight for Age)

SU- Severely Underweight BASELINE (UPON ENTRY) ENDLINE

UW-Underweight Total No. of Total No. of
Age Group Weight for Age STUNTING WASTING Weight for Age STUNTING WASTING
N- Normal Male Female
OW- Overweight 2 SU: SS: SW: SU: SS: SW:
Nutritional Status: (Height for Age) 3 UW: S: W: UW: S: W:
SS- Severely Stunted
S- Stunted 4 N: N:
N: N: N: N:
N- Normal
T- Tall
5 OW: T: OW: OW: T: OW:
Nutritional Status: (Wasting)
SW- Severely Wasted
Total Ob: TOTAL:
W- Wasted
TOTAL:
N- Normal
OW- Overweight
Ob- Obese Prepared by: Approved by: Concurred by:

GINA T. SUSON VIDAL T. CABATINGAN CAMILO S. BASACA JR.

__________________________________________________________________________
(Complete Name w/ Signature and date) (Complete Name w/ Signature and date) (Complete Name w/ Signature and date)
Child Development Worker Brgy. Captain C/ MSWDO /OIC - CSWS/HEAD