Department of Education

Region II

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

Division/Province: ISABELA Name of Principal : LORNA R. COLCOL

City/ Municipality/Barangay : Sampaloc, Cabatuan Name of Feeding Focal Person : JULIET A. LUNA
Name of School / School District : Cabatuan East Central School/Cabatuan East District

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

1 YHAEL B. FIGURACION M K-Angels Breath 6/26/2012 6/16/2017 13.5 0.99 Wasted Stunted Mishelle Figuracion No
2 KARL ALEXANDER A. JOAQUIN M K-Angels Breath 4/16/2012 6/16/2017 14 1 Wasted Stunted Danilo Joaquin No
3 APRILYN S. LUCENA F K-Angels Breath 4/5/2012 6/16/2017 14 0.96 Wasted Stunted Aileen Lucena No
4 ABIGAIL G. PASION F K-Angels Breath 7/18/2012 6/16/2017 13.5 0.97 Wasted Stunted Jovelyn Pasion No
5 WARLITO P. ANCHOLA JR. M K-Angels Breath 8/1/2012 6/16/2017 13.5 0.99 Wasted Stunted Warlito Anchola Sr. No
6 JESSIE L. BALAGAT JR. M K-Buttercup 6/14/2012 6/16/2017 14 0.98 Wasted Stunted Jessie Balagat Sr. No
7 JOHN KIRVY B. AGUILAR M K-Buttercup 8/7/2011 6/16/2017 15.5 1.08 Wasted Stunted Aimee Aguilar No
8 ELTON JOHN D. CADORNA M K-Buttercup 2/16/2012 6/16/2017 14.5 1.02 Wasted Stunted Santa Cadorna No
9 JARIS M. RIPARIP M K-Buttercup 9/18/2011 6/16/2017 14.5 0.99 Wasted SS Marissa Riparip No
10 NHASMIN JAY SALAZAR M K-Buttercup 11/14/2011 6/16/2017 14.5 1 Wasted Stunted Merry Joy Salazar No
11 KRIZHA-LYN S. NAZAR F K-Buttercup 11/21/2011 6/16/2017 14.5 1.02 Wasted Stunted Rhodlyn Nazar No
12 ESTHER O. PARUMOG F K-Buttercup 9/12/2011 6/16/2017 14 1.04 Wasted Stunted Esmer Parumog No
13 ARRIANE NICCOLET B. PAULINO F K-Buttercup 6/6/2012 6/16/2017 13.5 1.04 Wasted Stunted Leilani Paulino No
14 ELEONA HEART O. BITANTES F K-Buttercup 5/17/2012 6/16/2017 13.5 1.01 Wasted Stunted Venus Rimbiosa No
15 LEONARDO VENTURA JR. M K-Lotus 4/24/2012 6/16/2017 13 95 Wasted SS Mary Jane Ventura No

Prepared by: Noted :

JULIET A. LUNA LORNA R. COLCOL

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 DSWD-FO, copy furnished DepEd-HNC
 Department of Education
Region II

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

Division/Province: ISABELA Name of Principal : LORNA R. COLCOL

City/ Municipality/Barangay : Sampaloc, Cabatuan Name of Feeding Focal Person : JULIET A. LUNA
Name of School / School District : Cabatuan East Central School/Cabatuan East District

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

16 Gilsan Rivera F K-Lotus 4/15/2013 6/16/2017 63 14 94 Wasted SS Susan R. Rivera No

17 Princess Ann Rivera F K-Lotus 8/11/2012 6/16/2017 58 13.5 101 Wasted Normal Rochelle Rivera No
18 Brayan Jade C. Garcia M I- Sunflower 8/20/2011 6/16/2017 14 101 Wasted Stunted Benjamin Garcia Jr. No
19 Althea A. Andres F I- Sunflower 7/30/2011 6/16/2017 13.5 105 Wasted Normal Jaycel Andres Yes
20 Princess Diana A. Aquino F I- Sunflower 6/15/2011 6/16/2017 15 109 Wasted Normal Elpidio Aquino Yes
21 Joseph Benedict A. Duran M II-Lily 10/22/2008 6/16/2017 15 115 SW Stunted Benedicto Duran Yes
22 Shakirah Marie H. DeGuzman F II-Jasmine 4/20/2010 6/16/2017 17.5 118 Wasted Normal Nerisa H. Morales Yes
23 Kenneth Jhon A. Aquino M III-Rose 3/23/2009 6/16/2017 18.5 118 Wasted Normal Elpidio Aquino Yes
24 Carlo James Dela Cruz M IV-Daisy 4/1/2008 6/16/2017 19 119 Wasted Stunted Mary Jane Dela Cruz No
25 Jhon Clark L. Balagat M IV-Sampaguita 9/6/2006 6/16/2017 19.5 120 Wasted SS Jessie Balagat Sr. Yes
26 Janelle L. Dawang F V-Gumamela 3/31/2007 6/16/2017 23 132 Wasted Normal Noel Dawang No
27 Marc Jhon A. Aquino M V-Yellowbell 6/23/2007 6/16/2017 23 130 Wasted Normal Elpidio Aquino Yes
28 Fernando O. Dejeria M V-Yellowbell 11/14/2000 6/16/2017 40 160 Wasted Normal Rogelio Dejeria No
29 Michael Angelo S. Ulnagan M VI-Camia 4/19/2016 6/16/2017 22 129 Wasted Stunted Rudy Ulnagan Yes

Prepared by: Noted :

JULIET A. LUNA LORNA R. COLCOL

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 DSWD-FO, copy furnished DepEd-HNC
SBFP Form 1
Department of Education
Region ___

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

Division/Province: ______________________________________ Name of Principal : ____________________________________

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

BMI
Date of Weighing / Age in Weight Height for 6 4Ps ID
Date of Birth
No. Name Sex Grade & Section Measuring Years / y.o. Nutritional Status (NS) Ethnicity Disability Name of Parents
(MM/DD/YYYY)
(MM/DD/YYYY) Months (Kg) (cm)
and Number
above

1 YHAEL B. FIGURACION M K-Angels Breath 6/26/2012 6/16/2017 13.5 0.99 Wasted Stunted Mishelle Figuracion
2 KARL ALEXANDER A. JOAQUI M K-Angels Breath 4/16/2012 6/16/2017 14 1 Wasted Stunted Danilo Joaquin
3 APRILYN S. LUCENA F K-Angels Breath 4/5/2012 6/16/2017 14 0.96 Wasted Stunted Aileen Lucena
4 ABIGAIL G. PASION F K-Angels Breath 7/18/2012 6/16/2017 13.5 0.97 Wasted Stunted Jovelyn Pasion
5 WARLITO P. ANCHOLA JR. M K-Angels Breath 8/1/2012 6/16/2017 13.5 0.99 Wasted Stunted Warlito Anchola Sr.
6 JESSIE L. BALAGAT JR. M K-Buttercup 6/14/2012 6/16/2017 14 0.98 Wasted Stunted Jessie Balagat Sr.
7 JOHN KIRVY B. AGUILAR M K-Buttercup 8/7/2011 6/16/2017 15.5 1.08 Wasted Stunted Aimee Aguilar
8 ELTON JOHN D. CADORNA M K-Buttercup 2/16/2012 6/16/2017 14.5 1.02 Wasted Stunted Santa Cadorna
9 JARIS M. RIPARIP M K-Buttercup 9/18/2011 6/16/2017 14.5 0.99 Wasted SS Marissa Riparip
10 NHASMIN JAY SALAZAR M K-Buttercup 11/14/2011 6/16/2017 14.5 1 Wasted Stunted Merry Joy Salazar
11 KRIZHA-LYN S. NAZAR F K-Buttercup 11/21/2011 6/16/2017 14.5 1.02 Wasted Stunted Rhodlyn Nazar
12 ESTHER O. PARUMOG F K-Buttercup 9/12/2011 6/16/2017 14 1.04 Wasted Stunted Esmer Parumog
13 ARRIANE NICCOLET B. PAULI F K-Buttercup 6/6/2012 6/16/2017 13.5 1.04 Wasted Stunted Leilani Paulino
ELEONA HEART O. BITANTES F K-Buttercup 5/17/2012 6/16/2017 13.5 1.01 Wasted Stunted Venus Rimbiosa
LEONARDO VENTURA JR. M K-Lotus 4/24/2012 6/16/2017 13 95 Wasted SS Mary Jane Ventura
Prepared by: Noted :

JULIET A. LUNA LORNA R. COLCOL

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 DSWD-FO, copy furnished DepEd-HNC
Beneficiary of
SBFP in
Previous Years
(yes or no)

No
No
No
No
No
No
No
No
No
No
No
No
No
No
No
SBFP Form 2
Department of Education
Region II

SCHOOL-BASED FEEDING PROGRAM (SBFP)

Division/Province: ISABELA
City/ Municipality/Barangay : Sampaloc, Cabatuan
Name of School / School District : Cabatuan East Central School/Cabatuan, Isabela
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 are beneficiaries in
Wasted Wasted Beneficiaries No. of Ethnic Ben. No. of 4 Ps Ben. previous years Remarks

1. Kinder 0 17 17 0

2. Grade I 0 3 3 2

3. Grade II 1 1 2 2

4. Grade III 0 1 1 1

5. Grade IV 0 2 2 1

6. Grade V 0 3 3 1

7. Grade VI 0 1 1 1

Total 1 28 29 8

Prepared by:

JULIET A. LUNA
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 DSWD-FO, copy furnished DepEd-
HNC
SBFP Form 3
Department of Education
Region II

SCHOOL-BASED FEEDING PROGRAM (SBFP)

Division/Province: Isabela
School District/City/ Municipality : Cabatuan East District, Cabatuan, Isabela

Name of District Total

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

Cabatuan East Central School Sampaloc, Cabatuan, Isabela Sampaloc Lorna R. Colcol 29

Prepared by: Noted by:

JULIET A. LUNA LEGARDA GO, RN MANUEL ECLIPSE MD,MDO III

SBFP Focal Person 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-HNC
 SBFP Form 4

SCHOOL-BASED FEEDING PROGRAM

FOR THE MONTH OF ______________________ , SY _____________

Region 02
Division ISABELA School: CABATUAN EAST CENTRAL SCHOOL
District CABATUAN EAST Grade: __________ Section _____________________
School ID Number: 103165

ACTUAL FEEDING
PRE FEEDING
4Ps
NAME OF PUPIL Beneficiary Beneficiary Nutritional Status Deworming
(y or n) of Previous Ht Wt Date
SBFP
Age Sex (√ ) or Date
NS
(y or n) Birth 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 POQUIZ, Gizella L. N N 5,6 1/1/2011 F 97 12.5 7/17/2016 Severly Wasted
2 ANDRES, Althea A. N N 5 7/20/2011 F 102 11.5 7/17/2016 Severly Wasted
3 LUCENA, Airish S. Y Y 8,08 10/31/2007 F 114 15 7/8/2016 Severly Wasted
4 BERGONIA, Riam C. N Y 11,5 2/10/2005 F 122 17.5 7/8/2016 Severly Wasted
5 LABAYOG, Ejay Paul G. Y N 11,8 11/6/2004 M 156 26 7/8/2016 Severly Wasted
6 CACHO, Precious Aira G. N N 5,5 2/9/2011 F 101 14 7/17/2016 Wasted
7 AQUINO, Princess Daina A. N N 5,4 3/28/2011 F 103 13 7/17/2016 Wasted
8 GUILLERMO, Justine C. N N 6,7 10/29/2010 M 103 14 7/17/2016 Wasted
9 DURAN, Joseph Benedict A. N N 7,7 10/22/2008 M 111 15.5 7/17/2016 Wasted
10 DUNGO, King Jaymer Jade Y N 5,9 8/25/2010 M 104 15 7/17/2016 Wasted
11 BANIAGA, Roxanne Lee N N 5,1 8/8/2010 F 105 14.5 7/17/2016 Wasted
12 DE GUZMAN, Shakira Marie M. N N 6,1 4/20/2010 F 112 15 7/17/2016 Wasted
13 SANTOS, Hazel T. N N 5,1 8/15/2010 F 98 14 7/17/2016 Wasted
14 ALBUERA, Jay Mauriz J. N N 7 11/11/2009 F 114 16 7/8/2016 Wasted
15 AQUINO, Kenneth Jhon A. N N 7 3/23/2009 M 112 16.5 7/8/2016 Wasted
16 GARCIA, April C. Y N 7,1 4/14/2009 F 113 16 7/8/2016 Wasted
17 PASION, Glyzelle S. Y N 7 6/17/2009 F 113 16 7/8/2016 Wasted
18 BALAGAT, John Clark L. Y Y 9,1 9/16/2006 M 115 18 7/8/2016 Wasted
19 NAZARENO, Marjorie J. N N 8,07 12/2/2007 F 122 18 7/8/2016 Wasted
20 ESPIRITU, Mark Darrel M. N N 7,1 7/20/2008 M 118 13 7/8/2016 Wasted
21 AQUINO, Mark Jhon A. N N 9 6/23/2007 M 124 20 7/8/2016 Wasted
22 ULNAGAN, Michael Angelo S. Y Y 9,3 4/19/2006 M 112 20 7/8/2016 Wasted
23
24
25
TOTAL:
Prepared by:
LEGEND
JULIET AGUSTIN LUNA 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
Noted: W - Wasted U - Underweight ( √ ) - dewormed ( A ) - Absent, not served
N - Normal N - Normal (√√ ) - Present, served twice
LORNA R. COLCOL Ow - Overwieght Ow - Overwieght
ES Principal II O - Obese

Page 9
 jclg 2016
Note: This form shall be prepared by the school to be consolidated using SBFP Form 5

Page 10
 SBFP Form 4

SCHOOL-BASED FEEDING PROGRAM

FOR THE MONTH OF ______________________ , SY _____________

Region : 02
Division ISABELA School: CABATUAN EAST CENTRAL SCHOOL
District: CABATUAN EAST DISTRICT Grade: __________ Section _____________________
School ID Number: 103165

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 POQUIZ, Gizella L.
2 ANDRES, Althea A.
3 LUCENA, Airish S.
4 BERGONIA, Riam C.
5 LABAYOG, Ejay Paul G.
6 CACHO, Precious Aira G.
7 AQUINO, Princess Daina A.
8 GUILLERMO, Justine C.
9 DURAN, Joseph Benedict A.
10 DUNGO, King Jaymer Jade
11 BANIAGA, Roxanne Lee
12 DE GUZMAN, Shakira Marie M.
13 SANTOS, Hazel T.
14 ALBUERA, Jay Mauriz J.
15 AQUINO, Kenneth Jhon A.
16 GARCIA, April C.
17 PASION, Glyzelle S.
18 BALAGAT, John Clark L.
19 NAZARENO, Marjorie J.
20 ESPIRITU, Mark Darrel M.
21 AQUINO, Mark Jhon A.
22 ULNAGAN, Michael Angelo S.
23
24
25
TOTAL:

D. Actual Feeding

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

jclg 2016
page 2
 SBFP Form 4

SCHOOL-BASED FEEDING PROGRAM

FOR THE MONTH OF ______________________ , SY _____________

Region : 02
Division ISABELA School: CABATUAN EAST CENTRAL SCHOOL
District: CABATUAN EAST DISTRICT Grade: __________ Section _____________________
School ID Number: 103165

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 PASION, Glyzelle S.
2 ANDRES, Althea A.
3 LUCENA, Airish S.
4 BERGONIA, Riam C.
5 LABAYOG, Ejay Paul G.
6 CACHO, Precious Aira G.
7 AQUINO, Princess Daina A.
8 GUILLERMO, Justine C.
9 DURAN, Joseph Benedict A.
10 DUNGO, King Jaymer Jade
11 BANIAGA, Roxanne Lee
12 DE GUZMAN, Shakira Marie M.
13 SANTOS, Hazel T.
14 ALBUERA, Jay Mauriz J.
15 AQUINO, Kenneth Jhon A.
16 GARCIA, April C.
17 PASION, Glyzelle S.
18 BALAGAT, John Clark L.
19 NAZARENO, Marjorie J.
20 ESPIRITU, Mark Darrel M.
21 AQUINO, Mark Jhon A.
22 ULNAGAN, Michael Angelo S.
23
24
25
TOTAL:

D. Actual Feeding

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

jclg2016

page 3
 SBFP Form 4

SCHOOL-BASED FEEDING PROGRAM

FOR THE MONTH OF ______________________ , SY _____________

Region : 02
Division ISABELA School: CABATUAN EAST CENTRAL SCHOOL
District: CABATUAN EAST DISTRICT Grade: __________ Section _____________________
School ID Number: 103165

ACTUAL FEEDING POST FEEDING

ATTENDANCE
NAME OF PUPIL Nutritional Status Days Feeding
Percentage
Ht Wt Date Present Days
101 102 103 104 105 106 107 108 109 ### 111 112 113 114 115 116 117 118 119 120 cm kg Taken NS (A) (B) (A/B)*100
1 POQUIZ, Gizella L.
2 ANDRES, Althea A.
3 LUCENA, Airish S.
4 BERGONIA, Riam C.
5 LABAYOG, Ejay Paul G.
6 CACHO, Precious Aira G.
7 AQUINO, Princess Daina A.
8 GUILLERMO, Justine C.
9 DURAN, Joseph Benedict A.
10 DUNGO, King Jaymer Jade
11 BANIAGA, Roxanne Lee
12 DE GUZMAN, Shakira Marie M.
13 SANTOS, Hazel T.
14 ALBUERA, Jay Mauriz J.
15 AQUINO, Kenneth Jhon A.
16 GARCIA, April C.
17 PASION, Glyzelle S.
18 BALAGAT, John Clark L.
19 NAZARENO, Marjorie J.
20 ESPIRITU, Mark Darrel M.
21 AQUINO, Mark Jhon A.
22 ULNAGAN, Michael Angelo S.
23
24
25
TOTAL: AVERAGE:

D. Actual Feeding

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

jclg2016

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.