DEPARTMENT OF EDUCATION REGION III DepEd3-QAD-MET-038

Matalino St. D.M. Government Center, Maimpis, Version No. Rev. No

City of San Fernando (P) 1 01
IMPACT MONITORING AND EVALUATION TOOL ON THE IMPLEMENTATION OF
SCHOOL BASED FEEDING PROGRAM
DepEd Order 51, series 2016
DepEd Order 33, series 2015
DepEd Order 37, series 2014

This Tool shall be accomplished by the Adviser of the School-Based Feeding Beneficiaries.

Objective: To evaluate the impact of the School-Based Feeding Program.

DIVISION: _______________________________________
FOCAL (PERSON)S: ______________________________ SCHOOL YEAR: _____________
Direction: It will be administered two weeks before the implementation of the School-Based
Feeding Program on July 2017 and to be collected a week after the conduct of
this program on March 2018.

I. PRODUCT

A. Nutritional Status
No. of School-Based Feeding Recipients: _____________
Name of Nutritional Nutritional
Baseline Endline
Student Status Status

Note: Baseline data serves as input

B. Academic Performance
General General General General
Name of
Average for 1st Average for Average for Average for
Student
Quarter 2nd Quarter 3rd Quarter 4th Quarter

Note: General Average Data serves as an input

C. Monthly Attendance
Name
of July Aug. Sept. Oct. Nov. Dec. Jan. Feb. March
Student

Note: Monthly Attendance data serves as an input

MONITOR RESPONDENT

DESIGNATION/OFFICE DESIGNATION

DATE DATE

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Katanungan para sa mga magulang ng mga batang kabilang sa Feeding Program ng
Paaralan. Ito ay ibibigay ng Gurong Tagapayo sa kalagitnaan ng panahon ng pagpapatupad
ng programa.

Pangalan______________________ Petsa___________________
Pangalan ng Anak ______________ Tirahan__________________
Pangkat ____________

Panuto: Lagyan ng tsek ( / ) ang hanay ng inyong napiling sagot batay sa pamantayan na
nasa ibaba.

4- Lubos na sumasangayon
3- Sumasangayon
2- Hindi lubhang sumasangayon
1- Hindi sumasangayon

Ako ay ….
4 3 2 1
may kaalaman sa School Based Feeding
Program(SBFP)
may kabatiran na ang anak ko ay kasama sa
SBFP
aktibong nakikibahagi sa programa

naghahanda ng balanse at masustansyang

pagkain para sa aking pamilya.

Mula ng mapabilang sa SBFP, ang anak ko ay

…. 4 3 2 1

sumigla
lumakas ang pangangatawan
naging masipag sa pagpasok sa paaralan
gumana sa pagkain ngayon
madalang ng magkasakit
sumigla sa pakikipaglaro
mahimbing matulog

Pangalan ng Magulang

Tirahan

Petsa

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