SBFP Form 1 Annex 1

Department of Education
Region XII

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

SY 2019-2020
Division/Province: SOUTH COTABATO Name of Principal : JULIUS V. MINGLANA
City/ Municipality/Barangay : TAMPAKAN BRGY. TABLU Name of Feeding Focal Person : CRYSTAL M. CALLANO
Name of School / School District : TABLU ELEMENTARY SCHOOL TAMPAKAN DISTRICT III

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

1 JAMILARIN, SHERWIN M KINDER 08/28/2013 7/6/2019 /69 MOS 14.5 1.07 WASTED NO NO

2 MARATON MICHA JADE M KINDER 05/29/2014 7/6/2019 60 MOS 13.6 0.98 WASTED NO NO

3 TULI, BRED JOHN M KINDER 4/11/2013 7/6/2019 67 MOS 13.7 0.99 WASTED NO Shane Tuli NO

4 YONIDO, KENT JUN A, M KINDER 08/13.2013 7/6/2019 69 MOS 14.3 0.98 WASTED NO Mr.Jun and Mrs. Nerrisa Tuli NO

5 GOMEZ, ANGELICA F KINDER 01/24/2014 7/6/2019 64 MOS 14.2 0.97 WASTED NO Mr. Porperio and Mrs. Mercy Gomez NO

6 PAMPLONA, LOVELY F KINDER 05/26/2014 7/6/2019 60 MOS 12.7 0.94 WASTED NO Mrs. Gemma Pamplona NO

7 VASQUEZ, JANELLA P. F KINDER 7/9/2013 7/6/2019 69 MOS 14.7 1 WASTED NO Mr.Joasan and Mrs. Analyn Vasquez NO

8 TALADTAD, ANGEL MAE F KINDER 5/2/2014 7/6/2019 64 MOS 12.5 0.98 SEV. WASTED NO Mr. Dominador and Mrs. Angelita Taladtad NO

9 GO, JAYLORD M GRADE I 08/16/2013 7/6/2019 69 MOS 14.8 1.04 WASTED NO Mr. Jestony and Mrs. Lea Mae Go YES

10 MAN, LAUREL M GRADE I 3/10/2013 7/6/2019 68 MOS 14.7 1.03 WASTED NO Mrs. Gloria laurel YES

11 PULI, DELLMARK M GRADE I 6/8/2013 7/6/2019 69 M0S 14.5 1.01 WASTED NO Mr. Danny and Mrs. Michelle Puli YES

12 PULI, TANIELA M. F GRADE III 7/1/2011 7/6/2019 8,5 17 1.2 11.8 SEV. WASTED NO Mr. Taner and Mrs. Joy Ann Taniela YES

13 GOC, ROHELYO T. M GRADE IV 01/16/2010 7/6/2019 9,4 24 1.27 13.4 WASTED NO Mr. Peter and Mrs. Jelly Goc NO

14 BENTAY, EDWIN M. M GRADE VI 5/4/2005 7/6/2019 14, 2 35 1.52 15.1 WASTED NO Mr. Gosting and Aida Bentay NO

15 PULI, NOEL M GRADE VI 11/25/2008 7/6/2019 10 , 6 23 1.31 13.4 WASTED NO Mr. Nonoy and Mrs. Marlyn Puli NO
Prepared by: Noted :

CRYSTAL M. CALLANO JULIUS V. MINGLANA

Feeding Focal Person School Principal / Officer-in-Charge

Note: This form shall be prepared by the school, to be compiled by the DO, and for final compilation by the RO, for submission to DepEd BLSS-SHD
SBFP Form 3 Annex 3
Department of Education
Region XII

SCHOOL-BASED FEEDING PROGRAM (SBFP) SUMMARY OF BENEFICIARIES & START OF FEEDING

Division/Province: SOUTH COTABATO
City/ Municipality/Barangay : TAMPAKAN, BRGY. TABLU
Name of School / School District : TABLU ELEMENTARY SCHOOL TAMPAKAN DISTRICT III
School ID Number : 130864
Date of Start of Feeding: _________________________________

Nutritional Status at Start of Feeding Ethnicity 4 Ps Beneficiaries

Number of Undernourished School
Children by Grade Level No. of No. of Pupils who
Severely No. of Total No. of 4Ps are beneficiaries in
Wasted Wasted Beneficiaries Beneficiaries previous years Remarks

1. Kinder

2. Grade I

3. Grade II

4. Grade III

5. Grade IV

6. Grade V

7. Grade VI

Total

Prepared by:

______________________________________ _________________________________
 SBFP DepEd Focal

Note: This form shall be prepared by the school, to be compiled by the DO, and for final compilation by the RO, for submission to DedEd BLSS-SHD
SBFP Form 2 Annex 2
Department of Education
Region ___

SCHOOL-BASED FEEDING PROGRAM (SBFP) LIST OF SCHOOLS

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

Name of District Total

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

Prepared by: Noted by:

SBFP DepED Focal Unit Chief

Note: This form shall be prepared by the DO, for final consolidation by the RO, for submission to DSWD-FO, copy furnished DepEd BLSS-SHD
 SBFP Form 4 Annex 4

SCHOOL-BASED FEEDING PROGRAM

FOR THE MONTH OF ______________________ , SY _____________

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

ACTUAL FEEDING
PRE FEEDING
4Ps
NAME OF PUPIL Beneficiary Beneficiary Nutritional Status Deworming
(y or n) of Previous Ht Wt Date
SBFP
Age Birth Sex (√ ) or Date
NS
(y or n) Date cm kg Taken (X) Taken 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:
LEGEND
____________________________ A. Nutritional Status
B. Deworming D. Actual Feeding
Feeding Teacher / School Nurse For 6-19 y.o For below 6 y.o
SW - Severely wasted SU - Severely underweight ( x ) - not dewormed ( √ ) - Present, served
W - Wasted U - Underweight ( √ ) - dewormed ( A ) - Absent, not served
N - Normal N - Normal (√√ ) - Present, served twice
Ow - Overwieght Ow - Overwieght
O - Obese

Note: This form shall be prepared by the school to be consolidated using SBFP Form 5

Page 6
 SBFP Form 4

SCHOOL-BASED FEEDING PROGRAM

FOR THE MONTH OF ______________________ , SY _____________

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

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

( √ ) - Present, served
( A ) - Absent, not served
(√√ ) - Present, served twice

page 2
 SBFP Form 4

SCHOOL-BASED FEEDING PROGRAM

FOR THE MONTH OF ______________________ , SY _____________

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

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

( √ ) - Present, served
( A ) - Absent, not served
(√√ ) - Present, served twice

page 3
SBFP Form 1
Department of Education
Region XII

Master List Beneficiaries for School-Based Feeding P

SY 2019-2020
Division/Province: SOUTH COTABATO
City/ Municipality/Barangay : TAMPAKAN BRGY. TABLU
Name of School / School District : TABLU ELEMENTARY SCHOOL TAMPAKAN DISTRICT III

Date of
Grade/ Date of Birth Weighing / Age in Years Weight (Kg)
No. Name Sex Section (MM/DD/YYYY) Measuring / Months
(MM/DD/YYYY)

16 CAPION, MYKA F KINDER 09/22/2013 7/6/2019 68 MOS 16.3

17 GAROC, MIKAYLA F KINDER 08/16/2011 7/6/2019 7,9 15
18 ACUŇA, PETER JR. M GRADE I 6/2/2013 7/6/2019 6, 3 14.6
19 PULI, AKIHERO M GRADE I 7/8/2012 7/6/2019 6, 9 15.5
20 MORADOS, KITCHIE FATE F GRADE I 05/17/2012 7/6/2019 7,0 16.8
21 ALFAR, VINCENT M GRADE II 7/6/2012 7/6/2019 7,0 17.3
22 SANUHAY, DARLYN F GRADE II 10/4/2012 7/6/2019 7 ,1 15.3
23 DEBULGADO, JADE R. M GRADE III 03/16/2011 7/6/2019 8,2 18.2
24 GOMEZ, JHON REY M GRADE III 1/5/2008 7/6/2019 11 , 1 28
25 MALID, ELMER JOHN M GRADE III 03/30/2010 7/6/2019 9,1 19
26 PAMPLONA, JERALD M GRADE III 09/21/2010 7/6/2019 8,8 19
27 BAGOOD, JEAH F GRADE III 09/22/2010 7/6/2019 8,8 19
28 OBAŃA, MARIELLE ASHLEY F GRADE V 05/18/2008 7/6/2019 11 , 0 25.6
29 LAGNAS, JAYMARK M GRADE III 03/26/2011 7/6/2019 8,2 16
30 PARANGA, PRECIOUS KATE F GRADE V 04/18/2008 7/6/2019 11 , 1 27.8
Prepared by:

CRYSTAL M. CALLANO
Feeding Focal Person

Note: This form shall be prepared by the school, to be compiled by the DO, and for final compilation by the RO, for su
ent of Education
egion XII

aries for School-Based Feeding Program (SBFP)

Name of Principal : JULIUS V. MINGLANA

Name of Feeding Focal Person : CRYSTAL M. CALLANO
III

BMI for 6 Participation Beneficiary of SBFP

Nutritional Status in
Height (cm) y.o. and 4Ps (Yes or Name of Parents in Previous Years
above (NS)
No) (yes or no)
1.02 NORMAL NO Mr. Michael and Mrs. Vilma Capion NO
1.03 14.1 NORMAL NO Mrs. Dina Garoc NO
1.01 14.3 NORMAL NO Mr. Peter Sr. and Mrs. Noime Ibay YES
1.03 14.6 NORMAL NO Mr. Jerry and Mrs. Mila Puli YES
1.04 15.5 NORMAL YES Mr. Rudy Morados YES
1.05 15.6 NORMAL YES Mr. and Mrs. Jestoni Alfar NO
1.01 14.9 NORMAL NO Mr. Felipe and Mrs. Analyn Sanuhay YES
1.08 15.6 NORMAL YES Mr. Larry and Mrs. Rosalina Debulgado NO
1.22 18.8 NORMAL NO Mr. Porperio And Mrs. Mercy Gomez YES
1.07 16.5 NORMAL NO Mr. Jhonny And Mrs. Elsie Malid NO
1.1 15.7 NORMAL NO Mrs. Gemma Pamplona YES
1.1 15.7 NORMAL NO Mr. Bobby and Mrs. Jenevev Bagood YES
1.24 16.6 NORMAL YES Mr. Jennifer and Mrs. Fibe Obańa NO
1.04 14.7 NORMAL YES Mrs. Juanita R. Lagnas NO
1.22 18.6 NORMAL YES Mr. Jomeler and Mrs. Divina Paranga NO
Noted :

JULIUS V. MINGLANA
School Principal / Officer-in-Charge

al compilation by the RO, for submission to DepEd BLSS-SHD

SBFP Form 1
Department of Education
Region XII

Master List Beneficiaries for School-Based Feeding Program (S

SY 2019-2020
Division/Province: SOUTH COTABATO
City/ Municipality/Barangay : TAMPAKAN BRGY. TABLU
Name of School / School District : TABLU ELEMENTARY SCHOOL TAMPAKAN DISTRICT III

Date of
Grade/ Weighing / Age in Years
Date of Birth
No. Name Sex Measuring
/ Months Weight (Kg) Height (cm)
Section (MM/DD/YYYY) (MM/DD/YYY
Y)

31 SUMALPONG, JAERYL M GRADE V 05/17/2008 7/6/2019 11 , 0 20 1.16

32 MAGUMWAY, ANDREA L. F GRADE V 02/21/2008 7/6/2019 11 , 3 25 1.22
33 MAGUMWAY, KRISTINE L. F GRADE V 9/4/2008 7/6/2019 12 , 1 29.5 1.25
34 GALLEGO, RENAMIE M M GRADE VI 02/25/2008 7/6/2019 11 , 3 23 1.22
35 SANUHAY, CAMILLE F GRADE VI 12/6/2006 7/6/2019 12 , 11 28 1. 32

Prepared by:

CRYSTAL M. CALLANO
Feeding Focal Person Schoo

Note: This form shall be prepared by the school, to be compiled by the DO, and for final compilation by the RO, for su
tion

ool-Based Feeding Program (SBFP)

Name of Principal : JULIUS V. MINGLANA

Name of Feeding Focal Person : CRYSTAL M. CALLANO

Nutritional Participati
BMI for 6 Beneficiary of
y.o. and on in 4Ps Name of Parents SBFP in Previous
above Status (NS) (Yes or No) Years (yes or no)

14.8 NORMAL YES Mrs. Ana Yonido NO

16.7 NORMAL NO Mr. and Mrs. Berting Magumway NO
18.8 NORMAL NO Mr. Bernie and Mrs. Marina Magumway NO
15.4 NORMAL YES Mr. and Mrs. Elmondo Gallego YES
16 NORMAL NO Mr. Jay-R and Mrs. Sony Sanuhay NO

Noted :

JULIUS V. MINGLANA
School Principal / Officer-in-Charge

mpilation by the RO, for submission to DepEd BLSS-SHD

 SBFP Form 4

SCHOOL-BASED FEEDING PROGRAM

FOR THE MONTH OF ______________________ , SY _____________

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

ACTUAL FEEDING POST FEEDING

ATTENDANCE
NAME OF PUPIL Nutritional Status Days Feeding
Percentage
Ht Wt Date Present Days
101 102 ### 104 105 ### ### ### ### ### 111 112 113 114 115 116 117 118 119 120 cm kg Taken NS (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

( √ ) - Present, served
( A ) - Absent, not served
(√√ ) - Present, served twice

page 4
page 4
SBFP Form 5
SCHOOL-BASED FEEDING PROGRAM

CONSOLIDATED NUTRITIONAL STATUS AND ATTENDANCE REPORT

Region: _______
Division/District: ________________________
School: ________________________________
BEIS ID No.: ___________________________
NUTRITIONAL STATUS
No. of Pupils BEFORE AFTER PERCENTAGE
GRADES AND SECTIONS
Dewormed ATTENDANCE
SW/SU W/U N Ow Ob Total SW/SU W/U N Ow O Total
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
TOTAL AVERAGE:
Legend:
For 6-19 y.o For below 6 y.o
SW - Severely Wasted SU - Severely Underweight
W - Wasted U - Underweight
N - Normal N - Normal
Ow - Overweight Ow - Overweight
O - Obese
Prepared by: Noted by:
_____________________________ ___________________________
Classroom Adviser / School Nurse School Head

Note: This form shall be prepared by the school using the data from SBFP Form 4.