SBFP Form 1 (2023)

Department of Education
Region I
Master List Beneficiaries for School-Based Feeding Program (SBFP) ( SY 2022-2023 )

Schools Division Office: SDOI PANGASINAN Name of Principal: DR, MARCELINO R. JUNIO JR.
City/ Municipality/Barangay : BASISTA Name of Feeding Focal Person : RIZALYN C. ESPANOLA
Name of School / School District : OBONG ELEMENTARY SCHOOL
School ID Number: 101258
Parent's Particip
Date of Age in BMI Beneficiary
Nutritional consent ation in
Weighing / Years for 6 of SBFP in
No. Grade/ Date of Birth Weight Heigh Status (NS) for milk? 4Ps
Name Sex Measuring / y.o. Previous
(MM/DD/YYYY Month (Kg) t (cm) and
Section (MM/DD/YYYY)
Years (yes or
) (yes or (yes or
s above no)
BMI-A HFA no) no)

1 FORTIN , PETER JHON BATALLA M KINDER WASTED STUNTED NO NO

2 SOLIS, CYNRICK CATANA M KINDER WASTED NORMAL NO NO

3 DATUIN, DARLYN FAYE DE VERA M KINDER WASTED NORMAL NO NO

PAGADOR, OLICEL TALIYAH DE
4 VERA M KINDER WASTED NORMAL NO NO

5 MEJIA, ARKIEL JAKE BARTE M KINDER WASTED NORMAL NO NO

BULALACAO, ANTONETH
6 ETCUBANAS F KINDER WASTED NORMAL NO NO

7 VALDEZ, JANNA MENDOZA F KINDER WASTED NORMAL NO NO

8 DELA CRUZ, EFGHI ANTONIO M I-C WASTED NORMAL NO NO

SEVERELY
9 MARTIN, ANGHEL C. M 1-C WASTED STUNTED NO NO

10 MONDERIN, FRANCISCO II M. M 1-C WASTED NORMAL NO NO

11 MORALES, DARYLL GWEN C. M 1-C WASTED NORMAL YES NO

SEVERELY
12 NADONZA, GIBAR JR.DG. M 1-C WASTED NORMAL NO NO

13 TANEO, ALLIAH JUDE M. F 1-C WASTED NORMAL NO NO

14 CERENIO, JOHN PAUL B. M II-Z WASTED NORMAL NO NO

 Parent's Particip
Date of Age in BMI Nutritional Beneficiary
consent ation in
Weighing / Years for 6 of SBFP in
No. Grade/ Date of Birth Weight Heigh Status (NS) for milk? 4Ps
Name Sex (MM/DD/YYYY)
Measuring /
(Kg) t (cm)
y.o. Previous
Section (MM/DD/YYYY Month and BMI-A HFA Years (yes or
) (yes or (yes or
15 QUINTO,RYLINE FAYE DELA MASA F II-Z s above WASTED NORMAL YES no)
YES
no) no)
16 SAMERA, JULIA BRIANNA F II-Z WASTED NORMAL NO YES
SEVERELY
17 COLLADO, PRINCE CARL B. M II-S WASTED NORMAL YES YES
SEVERELY
18 RESULTAY, JOHN GABRIEL M. M II-S WASTEDSTUNTED NO YES
19 SARMIENTO, RHEGGIE ROUIS R. M II-S WASTED NORMAL YES YES
20 DE GUZMAN, RUTH ANNE L. F II-S WASTED NORMAL YES YES
21 RESULTAY, JANELLE M. F II-S WASTED NORMAL YES YES
22 FRIAS, JEZRYL JEZZA R. F II-S WASTED STUNTED YES YES
23 TOMI, ELAIZA MAE S. F II-S WASTED NORMAL YES YES
SEVERELY
24 QUINIO, JOSHUA D. M II-P WASTEDNORMAL NO YES
25 MAGAOGAO, AYESHA MAE C. F II-P WASTED STUNTED YES YES
26 MORALES, ERICA MAE LOMBOY F III-D WASTED NORMAL NO YES
SEVERELY
27 RESULTAY, MICAELA AUSTRIA F III-D WASTED NORMAL NO NO
28 DE PAZ, KENT ZYMON S. M IV-P WASTED NORMAL NO NO
29 MEJIA, JOSHUA M. M IV-P WASTED NORMAL NO NO
30 VALDEZ, JOHN CARLO J. M IV-P WASTED NORMAL NO NO
31 BOSANTE, KERSTEN DENIECE V. F IV-P WASTED STUNTED NO NO
32 FRIAS, CHRISTOPHER R. M V-F WASTED NORMAL YES NO
SEVERLY
33 ALVAREZ, PRINCESS ANGEL F V-F WASTEDNORMAL NO NO
34 BAUTISTA, JEREMIAH EZEKIEL I. M V-C WASTED NORMAL NO NO
35 PAGATPATAN, JOHN RUSSEL M. M V-C WASTED NORMAL NO NO
SEVERLY
36 VALDEZ, AR0JAY P. M V-C WASTEDNORMAL YES NO
37 MORALES, MERLITA S. F V-C WASTED NORMAL NO NO
38 DELA CRUZ, CEEJAY SAYGO M V-V WASTED NORMAL NO NO
39 DELA MASA, MARYJOY M. F V-V WASTED STUNTED NO NO
40 DE VERA, PATRICK R. M VI-L WASTED NORMAL NO NO
41 FRIAS, JAY-JAY C. M VI-L WASTED NORMAL YES YES
SEVERLY
42 VALDEZ, MARCO M. M VI-L WASTEDNORMAL YES YES
43 BERTILLO, JONALYN F VI-L WASTED NORMAL NO NO
44 DEL ROSARIO, CRISTINA MAE F VI-L WASTED NORMAL YES NO
45 FRIAS, AILEEN JOYCE F VI-L WASTED NORMAL YES NO
 SEVERELY
46 MORALES, JOVELYN U. F VI-L WASTEDSTUNTED YES NO
47 BUGAYONG, JACKSON C. M VI-B WASTED STUNTED YES NO
SEVERELY
48 CABANIT, GABRIEL MATEO M VI-B WASTED NORMAL NO NO
49 DELA CRUZ, MARK JAMES M VI-B WASTED NORMAL YES NO
50 MONDERIN, JOMEL M. M VI-B WASTED NORMAL YES NO
SEVERELY
51 MORALES, SANTINO D. M VI-B WASTED NORMAL YES YES
SEVERELY
52 DELALINGCO, JANELLA MYKA F VI-B WASTED NORMAL YES YES
SEVERELY
53 GAYOMALE, DANIELLA B. F VI-B WASTED NORMAL YES NO
SEVERELY
54 MARARC, JHENICA JEAN D. F VI-B WASTED NORMAL YES NO
SEVERELY
55 MORALES, KIMB\ERLY C. F VI-B WASTED NORMAL YES YES
56 SOLIS, MA. FELICIPE F VI-B WASTED NORMAL NO YES
57 MANIPON, EMBER JOY F VI-L WASTED NORMAL NO YES
58 MEJIA, RICA MAE D. F VI-L WASTED NORMAL NO NO
59 SOLIS, WINNIELYN A. F VI-L WASTED NORMAL NO NO

PREPARED BY: NOTED BY:

RIZALYN C. ESPANOLA MARCELINO R. JUNIO JR., Ph.D.

SBFP Focal Person School Head
SBFP Form 2 (2023)
Department of Education
Region XIII

SCHOOL-BASED FEEDING PROGRAM (SBFP) SUMMARY OF BENEFICIARIES & START OF FEEDING (SY_:2023-2024_______)
Schools Division Office: PANGASINAN 1
City/ Municipality/Barangay : OBONG, BASISTA
Name of School / School District : OBONG ELEMENTARY SCHOOL/BASISTA
School ID Number: 101258
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
Learners Beneficiari Pupils who
Number of No. of Dewormed es are
Undernourished School Severely Wasted
Normal Overwe Severely Stunt Nor Tall No. of No. of No. of
Pupils-at- Stunted/ Indigent Indigenou beneficiari
Children by Grade Wasted ight Stunted ed mal es in
risk-of- Severely Learners s Peoples
Level + dropping- Stunted previous
Obese (IPs) years
out
(PARDOs) (Repeaters

1. Kinder 0 7

2. Grade I 4 2

3. Grade II 3 9

4. Grade III 1 1

5. Grade IV 0 4

6. Grade V 2 6

7. Grade VI 8 12

Total 18 41
Prepared by: RIZALYN C. ESPANOLA Approved by: MARCELINO R. JUNIO JR., Ph.D.
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/En
ded

mpilation by the RO,

SBFP Form 3 (2023)

Region: 1
SDO: PANGASINAN I School: OBONG ELEMENTARY SCHOOL
District: BASISTA School ID Number: 101258
Grade: __________ Section _____________________
ACTUAL FEEDING

1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20

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

ACTUAL FEEDING

1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20
Riosa, Giezel Raine R.
Bayer, Lovely Ann
Sulit, Lance Matteo M.
Cordero,Brent Andrew A.
Cordero, Mark Francis A.
Perez, Roncedric F.
Gonzales,Kim Patrick B.
Arnaiz,Kris A.
Barza, Ayesha Jhoana L.
Gonzales,VJ E.
Malco, John Archie E

Prepared by:
____________________________
B. Deworming D. Actual Feeding
Feeding Teacher / School Nurse
( x ) - not dewormed (H ) - Present, served with Hot meals
Approved by: ( √ ) - dewormed (M ) - Present, served with Milk
(H/M ) - Present, served with Hot meals & Milk
( A ) - Absent, not served
School Head (H2/M2/(H/M2)) - Present, served twice
SBFP Form 5 (2020)

SBFP Form 4 (2023)

DEPARTMENT OF EDUCATION
Region: IX

REGION/SDO/DISTRICT:
NAME OF SCHOOL:
SCHOOL ID NO.:
SCHOOL-BASED FEEDING PROGRAM - MILK COMPONENT
LIST OF AUTHORIZED CONSIGNEES (SY: 2022-2023)
NAME & DESIGNATION TEL. NO.MOBILE NO. EMAIL ADD SPECIMEN
SIGNATURE
1

SCHOOL INSPECTION TEAM (SY________)

NAME & DESIGNATION TEL. MOBILE EMAIL ADD SPECIMEN
NO. NO. SIGNATURE
1

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

Use long hand signature.
SBFP Form 5 (2021)

SBFP Form 5 (2023)

DEPARTMENT OF EDUCATION
Region ___

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

SCHOOL-BASED FEEDING PROGRAM - MILK COMPONENT

LIST OF BENEFICIARIES (SY________)

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

Prepared by: APPROVED BY:

School Feeding Coordinator School Head

SBFP Form 6 (2021)

SBFP Form 6 (2023)

DEPARTMENT OF EDUCATION
Region ___

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

SCHOOL-BASED FEEDING PROGRAM

NFP DELIVERIES (SY________)

Grade Level Number of Beneficiaries Date No. of Packs Received No. of Packs for Remarks
Delivered Replacement/
New Replacement Total (New + Rejected
Replacement)

Kinder 5
Grade 1 4

Grade 2 5
Grade 3 3

Grade 4 4
Grade 5 4

Grade 6 6

TOTAL: 31

Prepared by:

APPROVED BY:

School Feeding Coordinator School Head

SBFP Form 6 (2021)

MILK DELIVERIES (SY________)

Grade Level Number of Beneficiaries Date No. of Packs Received No. of Packs for Remarks
Delivered Replacement/
New Replacement Total (New + Rejected
Replacement)

Kinder 5
Grade 1 4
Grade 2 5

Grade 3 3
Grade 4 4
Grade 5 4
Grade 6 6

TOTAL: 31

Prepared by: APPROVED BY:

School Feeding Coordinator School Head