SBFP Form 1 (2020)

Department of Education
Region ___

Master List Beneficiaries for School-Based Feeding Program (SBFP) (SY 2023-2024)

Division/Province: MISAMIS ORIENTAL Name of Principal : GEMMA C. GABE

City/ Municipality/Barangay : NAAWAN/ LINANGKAYAN Name of Feeding Focal Person : FELY G. ACERA
Name of School / School District : Linangkayan Elementary School / Naawan District
School ID Number: 127929

BMI Nutritional Parent's

Participation Beneficiary of
Grade/ Date of Birth Date of Weighing / Age in Weight Height for 6
Status (NS) Dewormed consent for
in 4Ps SBFP in
No. Name Sex Section
Measuring Years / y.o. ? milk?
(MM/DD/YYYY) (MM/DD/YYYY) Months (Kg) (cm)
and (yes or no) (yes or
(yes or Previous Years
no) (yes or no)
above no)
BMI-A HFA

1 Gabisay, Kylen Nicole A. F K2 5/14/2018 9/4/2023 63mos 12 1.04 SW N yes yes no no

2 Taganas, Jun Riel A. M K2 8/19/2018 9/4/2023 60mos 11 0.96 SW SS yes yes no no
3 Ubanan, Jeriel L. M K2 1/15/2018 9/4/2023 67mos 13 1.05 SW N yes yes no no
4 Collantes, Lorenz Jay C. M G1 7/18/2016 9/4/2023 7,1 11.3 0.98 11.7 SW SS yes yes no no
5 Mangubat, Jaden Rose L. F G1 6/14/2016 9/4/2023 7,2 14.5 1.11 11.7 SW N yes yes no yes
6 Abbas, Jamante N. M G1 12/11/2015 9/4/2023 7,8 14.5 1.17 10.5 SW N yes yes no no
7 Bagares, Markus Onyx B. M G1 12/14/2016 9/4/2023 6,8 16.5 1.18 11.8 SW N yes yes no no
8 Paylaga, Leah Mae E. F G1 5/16/2017 9/4/2023 6,3 12 1.07 10.4 SW N yes yes no no
9 Barrero, Zian Lee I. M G2 5/20/2016 9/4/2023 7,3 14.6 1.17 10.6 SW N yes yes no yes
10 Lagrosas, Von Andrei A. M G2 11/9/2015 9/4/2023 7,9 17.4 1.185 12.3 SW N yes yes no no
11 Bacadon, Raphael M G2 12/28/2015 9/4/2023 7,8 15.5 1.15 11.7 SW N yes yes no yes
12 Bacadon, Norgan M G2 10/5/2016 9/4/2023 6,10 15.5 1.13 12.1 SW N yes yes no yes
13 Logatiman, Richelle P. F G2 11/24/2015 9/4/2023 7,9 13.5 1.09 11.3 SW N yes yes no yes

14 Cuizon, Jeserkuram D. M G3 6/23/2015 9/4/2023 8,2 14.3 1.246 9.2 SW N yes yes no no
15 Dalayag, Edimar A. M G3 9/20/2014 9/4/2023 8,11 18.2 1.25 11.5 SW N yes yes no no

16 Perez, Princess Julia J. F G3 8/31/2014 9/4/2023 9,0 20 1.306 11.7 SW N yes yes yes no

17 Taganas, Jhonafe A. F G3 10/7/2014 9/4/2023 8,10 14.7 1.109 11.9 SW SS yes yes no no

18 Apostol, Reanjoe Jesus G. M G3 12/19/2014 9/4/2023 8,8 15 1.32 18.6 SW N yes yes no no

19 Daganio, June Art H. M G3 6/14/2015 9/4/2023 8,2 15 1.1 12.3 SW SS yes yes yes no
 20 Macasero, Neil Jr. R. M G3 3/3/2015 9/4/2023 8,6 15 1.21 10.2 SW N yes yes no no
21 Macadildig, Jose Rene Jr. V. M G4 8/8/2013 9/4/2023 10,0 14.7 1.17 10.7 SW SS yes yes yes no

22 Dayday, Shanen E. F G4 12/19/2013 9/4/2023 9,8 21.9 1.299 12.9 W N yes yes no no

23 Cabunoc, Mark Lawrence E. M G4 5/3/2014 9/4/2023 9,4 18.7 1.23 12.3 SW N yes yes no no

24 Vina, Vinze M G4 6/1/2014 9/4/2023 9,3 14.6 1.2 10.1 SW S yes yes no no

25 Macasero, Aprille Rose B. F G4 4/1/2014 9/4/2023 9,5 16.3 1.16 12.1 SW SS yes yes no no

26 Realda, Princess Nicole P. F G4 10/3/2013 9/4/2023 9,11 22 1.38 11.5 SW N yes yes yes no

27 Roflo, Raphael E. M G4 9/12/2013 9/4/2023 9,11 22 1.3 11.5 SW N yes yes no no

28 Dumadaug, Ardie Jherome T. M G5 7/29/2013 9/4/2023 10,1 21 1.278 12.8 W N yes yes no yes

29 Otlag, Vergelio Jr. M G6 1/12/2008 9/4/2023 15,7 35 1.56 14.3 SW N yes yes no no

30 Regidor, Aliana Nicole D. F G6 7/12/2011 9/4/2023 12,1 16.8 1.43 13.1 SW N yes yes yes no

31 Santiago, Marcelyn A. F G6 2/11/2012 9/4/2023 11,6 21.7 1.359 11.7 SW N yes yes no no

32 Gaa, Kenth James M. M G6 7/5/2011 9/4/2023 12,2 23.1 1.31 13.4 SW SS yes yes yes no

Approved by:

GEMMA C. GABE
_____FELY G. ACERA 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.
SBFP Form 1 (2020)
Department of Education
Region ___

Master List Beneficiaries for School-Based Feeding Program (SBFP) (SY________)

Division/Province: ______________________________________ Name of Principal : ____________________________________

City/ Municipality/Barangay : ____________________________ Name of Feeding Focal Person : _________________________
Name of School / School District : _________________________
School ID Number: _________________________

BMI Nutritional Parent's

Participation Beneficiary of
Grade/ Date of Birth Date of Weighing / Age in Weight Height for 6
Status (NS) Dewormed consent for
in 4Ps SBFP in
No. Name Sex Section
Measuring Years / y.o. ? milk?
(MM/DD/YYYY) (MM/DD/YYYY) Months (Kg) (cm)
and (yes or no) (yes or
(yes or Previous Years
no) (yes or no)
above no)
BMI-A HFA

Prepared by: Approved by:

__________________________________ 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.
SBFP Form 2 (2020)
Department of Education
Region ___

SCHOOL-BASED FEEDING PROGRAM (SBFP) LIST OF SCHOOLS (SY________)

Division/Province: ______________________________________
School District/City/ Municipality : ____________________________

Name of District
Name of Schools BEIS ID No. School Address Name of Barangay Contact Number or & Total
Supervisors/
Email Address Beneficiaries
School Principal or OICs

Prepared by: Approved by:

SBFP DepED Focal Schools Division Superintendent

Note: This form shall be prepared by the SDO before the start of feeding, for final consolidation by the RO.
SBFP Form 3 (2020)
Department of Education
Region ___

SCHOOL-BASED FEEDING PROGRAM (SBFP) SUMMARY OF BENEFICIARIES & START OF FEEDING (SY________)
Division/Province: ______________________________________
City/ Municipality/Barangay : ____________________________
Name of School / School District : _________________________
School ID Number: _________________________
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
Learners Beneficiaries who are
SW W N OW+O SS S N T No. of Pupils- No. of No. of No. of Dewormed beneficiaries
Number of Undernourished School at-risk-of- in previous
Children by Grade Level Stunted/ Indigent Indigenous
dropping-out years
Severely Learners Peoples (IPs) (Repeaters)
(PARDOs) Stunted

1. Kinder

2. Grade I

3. Grade II

4. Grade III

5. Grade IV

6. Grade V

7. Grade VI

Total

Prepared by: Approved by:

______________________________________
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
 Date Feeding
Started/Ended

DepEd BLSS-SHD
 SBFP Form 4 (2020)
SCHOOL-BASED FEEDING PROGRAM
RECORD OF DAILY FEEDING

FOR THE MONTH OF ______________________ , SY _____________

Region ____________________________
Division ___________________________ School: _____________________________________
District ___________________________ Grade: __________ Section _____________________
School ID Number: _________________________
NAME OF PUPIL ACTUAL FEEDING

1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
TOTAL:
Prepared by:

__________________________
Feeding Teacher / School Nurse
Approved by:
School Head
B. Deworming D. Actual Feeding
( x ) - not dewormed (H ) - Present, served with Hot meals
( √ ) - dewormed (M ) - Present, served with Milk
(H/M ) - Present, served with Hot meals & Milk
( A ) - Absent, not served
(H2/M2/(H/M2)) - Present, served twice

Note: This form shall be prepared by the school to be consolidated using the Revised OKD Form A.
Page 7
 SBFP Form 4 (2020)

SCHOOL-BASED FEEDING PROGRAM

FOR THE MONTH OF ______________________ , SY _____________

Region ____________________________
Division ___________________________ School: _____________________________________
District ___________________________ Grade: __________ Section _____________________
School ID Number: _________________________

ACTUAL FEEDING

NAME OF PUPIL

21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 43 44 45 46 47 48 49 50 51 52 53 54 55 56 57 58 59 60
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
TOTAL:

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 2
 SBFP Form 4 (2020)

SCHOOL-BASED FEEDING PROGRAM

FOR THE MONTH OF ______________________ , SY _____________

Region ____________________________
Division ___________________________ School: _____________________________________
District ___________________________ Grade: __________ Section _____________________
School ID Number: _________________________

ACTUAL FEEDING

NAME OF PUPIL

61 62 63 64 65 66 67 68 69 70 71 72 73 74 75 76 77 78 79 80 81 82 83 84 85 86 87 88 89 90 91 92 93 94 95 96 97 98 99 100
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
TOTAL:

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 3
 SBFP Form 4 (2020)

SCHOOL-BASED FEEDING PROGRAM

FOR THE MONTH OF ______________________ , SY _____________

Region ____________________________
Division ___________________________ School: _____________________________________
District ___________________________ Grade: __________ Section _____________________
School ID Number: _________________________

ACTUAL FEEDING
ATTENDANCE
NAME OF PUPIL No. of No. of
Days Feeding Percentage
Present Days
### 102 ### ### ### ### ### ### ### ### ### 112 113 114 115 116 117 118 119 120 (A) (B) (A/B)*100
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
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 5 (2020)

DEPARTMENT OF EDUCATION
Region ____

REGION/DIVISION/DISTRICT: ____________________________________________________________________
NAME OF SCHOOL: ____________________________________________________________________
SCHOOL ID NO.: ____________________________________________________________________

SCHOOL-BASED FEEDING PROGRAM - MILK COMPONENT

LIST OF AUTHORIZED CONSIGNEES (SY________)

NAME & DESIGNATION TEL. NO. MOBILE NO. EMAIL ADD SPECIMEN
SIGNATURE
1 (School Head)

2 (School Feeding Coordinator)

3 (School Property Custodian)

Note: This form shall be filled-up by School Drop-off points to be given to the NDA/Dairy Cooperative supplier on the first
delivery of milk. Only authorized consignees are allowed to receive the goods.
SBFP Form 5 (2020)
 SBFP Form 6 (2020)

DEPARTMENT OF EDUCATION
Region ___

REGION/DIVISION/DISTRICT: ______________________________________________________________________________
NAME OF SCHOOL: ______________________________________________________________________________
SCHOOL ID NO.: ______________________________________________________________________________

SCHOOL-BASED FEEDING PROGRAM - MILK COMPONENT

LIST OF BENEFICIARIES (SY________)

(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

Prepared by: APPROVED BY:

School Feeding Coordinator School Head

 SBFP Form 7 (2020)

DEPARTMENT OF EDUCATION
Region ___

REGION/DIVISION/DISTRICT: ______________________________________________________________________________
NAME OF SCHOOL: ______________________________________________________________________________
SCHOOL ID NO.: ______________________________________________________________________________

SCHOOL-BASED FEEDING PROGRAM - MILK COMPONENT

MILK DELIVERIES (SY________)

Grade Level Number of Beneficiaries Date No. of Packs Received No. of Packs for
Delivered Replacement/
New Replacement Total (New + Rejected
Replacement)
Kinder
Grade 1
Grade 2
Grade 3
Grade 4
Grade 5
Grade 6
TOTAL:
Prepared by: APPROVED BY:

School Feeding Coordinator School Head

 SBFP Form 7 (2020)

MENT OF EDUCATION
Region ___

NG PROGRAM - MILK COMPONENT

VERIES (SY________)
Remarks
 SBFP Form 7 (2020)

DEPARTMENT OF EDUCATION
Region ___

REGION/DIVISION/DISTRICT: ______________________________________________________________________________
NAME OF SCHOOL: ______________________________________________________________________________
SCHOOL ID NO.: ______________________________________________________________________________

SCHOOL-BASED FEEDING PROGRAM - MILK COMPONENT

MILK DELIVERIES (SY________) FOR DROP-OFF POINTS

Date Delivered No. of Packs Received Allocation per School

New Replacement Total (New + Schools Number of

Replacement) Beneficiries
1 1
2
3
4
5
6
7
8
9
10

TOTAL:

Date Delivered No. of Packs Received Allocation per School

New Replacement Total (New + Schools Number of
Replacement) Beneficiries
2 1
2
3
4
5
6
7
8
9
10
TOTAL:

Date Delivered No. of Packs Received Allocation per School

New Replacement Total (New + Schools Number of
Replacement) Beneficiries
3 1
2
3
4
5
6
7
 SBFP Form 7 (2020)

8
9
10
TOTAL:

Date Delivered No. of Packs Received Allocation per School

New Replacement Total (New + Schools Number of
Replacement) Beneficiries
4 1
2
3
4
5
6
7
8
9
10
TOTAL:

Date Delivered No. of Packs Received Allocation per School

New Replacement Total (New + Schools Number of
Replacement) Beneficiries
5 1
2
3
4
5
6
7
8
9
10
TOTAL:

Date Delivered No. of Packs Received Allocation per School

New Replacement Total (New + Schools Number of
Replacement) Beneficiries
6 1
2
3
4
5
6
7
8
9
10
TOTAL:

Date Delivered No. of Packs Received Allocation per School

New Replacement Total (New + Schools Number of
Replacement) Beneficiries
7 1
2
7 SBFP Form 7 (2020)

3
4
5
6
7
8
9
10
TOTAL:

Date Delivered No. of Packs Received Allocation per School

New Replacement Total (New + Schools Number of
Replacement) Beneficiries
8 1
2
3
4
5
6
7
8
9
10
TOTAL:

Prepared by: APPROVED BY:

School Feeding Coordinator School Head

 SBFP Form 7 (2020)

ENT OF EDUCATION
Region ___

NG PROGRAM - MILK COMPONENT

_______) FOR DROP-OFF POINTS

Allocation per School

Number of Milk
Allocation

Allocation per School

Number of Milk
Allocation

Allocation per School

Number of Milk
Allocation
SBFP Form 7 (2020)

Allocation per School

Number of Milk
Allocation

Allocation per School

Number of Milk
Allocation

Allocation per School

Number of Milk
Allocation

Allocation per School

Number of Milk
Allocation
SBFP Form 7 (2020)

Allocation per School

Number of Milk
Allocation
SBFP Form 8 (2020)

DEPARTMENT OF EDUCATION
Region ___

SCHOOL-BASED FEEDING PROGRAM MONTHLY/QUARTERLY REPORT (SY________)

Region/Division: ____________________

Financial Status

Status of Implementation
(when Amount Liquidation Remarks (state if
Target No. Actual No. % Status of
No. of SDO started, completed, Downloaded fully/partially
Division/Schools of SBFP of SBFP downloading of
Schools (SBFP discontinue, for Amount to /Received liquidated &
Schools Schools Schools/SDO funds to Schools Disbursed
Schools) continuation or number of Allocated by SDOs or reason)
or to NDA/PCC for
feeding days completed) NDA/PCC 1st 2nd
milk
for milk

Prepared by: Approved by:

RO/SDO Focal Person Regional Director/ Schools Division Superintendent

RO/SDO Accountant