Form 1 - Classroom Level Annex A1

School-based Weekly Iron Folic Acid (WIFA) Supplementation

Region: ______________III Division: ______ CITY OF SAN JOSE DEL MONTE Date: ________________________________ School Year: ____ 2017-2018
School IC: _______________ Name of School: _____ SAPANG PALAY NATIONAL HIGH SCHOOL
Grade Level/Section: 8- MANGO No. of Students Enrolled: ___ 44 No. of Female Learners: 31 Address: _______ FATIMA V AREA E

Provided with Irno Folic Acid Supplements

Consent* 1st Round 2nd Round
LRN NAME OF LEARNER July August September January February March Remarks

Y N W1 W2 W3 W4 W1 W2 W3 W4 W1 W2 W3 W4 W1 W2 W3 W4 W1 W2 W3 W4 W1 W2 W3 W4
(date) (date) (date) (date) (date) (date) (date) (date) (date) (date) (date) (date) (date) (date) (date) (date) (date) (date) (date) (date) (date) (date) (date) (date)
1 BALTAZAR , CAITH SAMANTHA ARADA
2 BAUTISTA , JEJO MARY COCSON
3 BEREBER , SOPHIA DOROTHY BALANSAY
4 BIAG , PAULA NICOLE ALEJANDRO
5 BODOSO , ERICA MAE FORTES
6 CAOILI , SHANE TRIXIE BAYOMBON
7 Capa, Nicole Buquel
8 CARDENAS , JONHEART MARIE BANAL
9 CASTAÑARES , BERNADETTE GALLAZA
10 CASTAÑEDA , ZHIANNE LOUISSE NEYPES
11 CRUZ , SAMANTHA NICOLE NOCES
12 DECIPULO , ZAMANTHA MAE ICAY
13 DELOS REYES , HANNAH SAM GABAGAT
14 DIZON , ALEXDY NATALIE ESCOBER
15 Donadillo, Criselda Jane Liberta
16 Elagio, Zaira Eborde
17 FALLARCUNA , YASMIEN FAJILAGOT
18 FRANCISCO , JOSHLEN MAE MARFIL
19 Gajelan , Joyce Lyn Maramba
20 GAVIOLA , ROSE NICOLE DAYAWON
21 GERONIMO , MICAELLA ENTICO
22 Manuel , Jamie Lee Baque
23 MARTINEZ , MA ALTHEA MAY BALMEDINA
24 MENDOZA , ROIZEL JADE BADEO
25 Pachoco, Shanti Garrino
26 PACQUIAO , LEORA MAE CABIGQUIZ
27 PORTES , CYRENE MAE MARIANO
28 ROSEL , RAELLA MARIE HABANA
29 Saludo, Kristine Joy Bance
30 Tacderas, Mariel Anne Alajinio
31 Tamayo, Mhyka Mae Topinio
*Consent given Administered by: Noted by:
____________________
______________________ ____________ _____ ____________
Class Adviser Date Grade Level Teacher Date
Form 1 - Classroom Level Annex A1
School-based Weekly Iron Folic Acid (WIFA) Supplementation

Region: _______ III Division: ______ CITY OF SAN JOSE DEL MONTE Date: ________________________________ School Year: _____ 2017-2018
School IC: _______________ Name of School: _____ SAPANG PALAY NATIONAL HIGH SCHOOL
Grade Level/Secti8-AVOCADO No. of Students Enrolled: ___ 50 No. of Female Learners: 28 Address: ________ FATIMA V AREA E

Provided with Irno Folic Acid Supplements

Consent* 1st Round 2nd Round
LRN NAME OF LEARNER July August September January February March Remarks

Y N W1 W2 W3 W4 W1 W2 W3 W4 W1 W2 W3 W4 W1 W2 W3 W4 W1 W2 W3 W4 W1 W2 W3 W4
(date) (date) (date) (date) (date) (date) (date) (date) (date) (date) (date) (date) (date) (date) (date) (date) (date) (date) (date) (date) (date) (date) (date) (date)
1 Abraham , Claire Anne Marie Pon-An
2 ALPINO , REILA ABEGAIL DALAWAMPU
3 Baňas, Laila Relata
4 BERNARDINO, ANGEL JOYCE M.
5 BUSTAMANTE , DAIZIE MAE GALZOTE
6 Delambaca, Julie Ann Ocio
7 Delos Reyes , Danilyn Mendoza
8 Dioso , Marielle Bacani
9 Englatera , Karla Yusikee
10 Evasco , Glyzza Reign Lazaro
11 FUENTES, SHAIRI JEAN T.
12 GONZALES , RONACHEL SAN LUIS
13 IGNACIO , KRIZELLE FAME VALENZUELA
14 Lope, Alyssa Claire Biong
15 Mabini, Nicholaene Macawili
16 MAMARADLO, RAISSA L.
17 MENDOZA , KAIRA MAE ALCARAZ
18 MIZUTANI , MEGU BINASBAS
19 MONTANO , CRYSTAL JANE -
20 Ordoñez , Dyan Joy Cayabyab
21 PAYURAN , ROEFYAO MANDAPAT
22 Reyes, Paula Jane De Leon
23 RODRIGUEZ , LOVELY -
24 Roslin, Ma Angelica Cloma
25 SAN DIEGO , KAYCEE GUNITA
26 Simon, Rupert Joy Espadero
27 Torrenueva, Shari Mae Arsenio
28 VERJA , ALYSSA PELIÑO
Form 1 - Classroom Level Annex A1
School-based Weekly Iron Folic Acid (WIFA) Supplementation

Region: _ III Division: ______ CITY OF SAN JOSE DEL MONTE Date: ________________________________ School Year: _____ 2017-2018
School IC: _______________ Name of School: _____ SAPANG PALAY NATIONAL HIGH SCHOOL
Grade Level/Section: _8-CHICO No. of Students Enrolled: ___ 54 No. of Female Learners: 29 Address: ________ FATIMA V AREA E

Provided with Irno Folic Acid Supplements

Consent* 1st Round 2nd Round
LRN NAME OF LEARNER July August September January February March Remarks

Y N W1 W2 W3 W4 W1 W2 W3 W4 W1 W2 W3 W4 W1 W2 W3 W4 W1 W2 W3 W4 W1 W2 W3 W4
(date) (date) (date) (date) (date) (date) (date) (date) (date) (date) (date) (date) (date) (date) (date) (date) (date) (date) (date) (date) (date) (date) (date) (date)
1 ADVINCULA , MECAELA ATANACIO
2 Alipio , Mikylla Matterig
3 AMOR , MARY ABIGAIL BELIBER
4 Ampaso, Hasmin D.
5 Arcangel, Jenny Leaňo
6 Arriesgado, Ma Rizzalyn Mata
7 BANSIL , BERNADETTE ANDAL
8 Barbado, Gemimah Faith Manapat
9 Callahan, Jhennie Lyn Arriola
10 Castro , Mariefe Samonte
11 Collado, Ray Ann C.
12 Cuesta, Suzzette I.
13 DINALO , ERICA -
14 Enecito, Jasmine Mariz Ebuňa
15 Estrada, Shannien Reyel
16 GRECIA , ALSHAMYR YOMI MANGAHAS
17 GUMABON, GENESIS JOIE
18 Iradiel, Tricia Caday
19 Lanipga, Antoinette Joy Dela Cruz
20 Masmela , Colleen Joyce Mallari
21 Maturan, Jhona Mae S.
22 Miradora, Francine Lazaro
23 Montalban, Erica Ann Guinto
24 Pladero , Angel Nicole Erlanda
25 RABINO , AZENITH JOY CAJANDAB
26 RULLODA , NATHALIE MALABANAN
27 TALADRO , RUBELY SALAZAR
28 TORRES , LEILANI STA JUANA
29 Vinluan, Prescila Salvacion
Form 1 - Classroom Level Annex A1
School-based Weekly Iron Folic Acid (WIFA) Supplementation

Region: _ III Division: ______ CITY OF SAN JOSE DEL MONTE Date: ________________________________ School Year: _____ 2017-2018
School IC: _______________ Name of School: _____ SAPANG PALAY NATIONAL HIGH SCHOOL
Grade Level/Section: 8-CALAMANSI No. of Students Enrolled: ___ 54 No. of Female Learners: 31 Address: ________ FATIMA V AREA E

Provided with Irno Folic Acid Supplements

Consent* 1st Round 2nd Round
LRN NAME OF LEARNER July August September January February March Remarks

Y N W1 W2 W3 W4 W1 W2 W3 W4 W1 W2 W3 W4 W1 W2 W3 W4 W1 W2 W3 W4 W1 W2 W3 W4
(date) (date) (date) (date) (date) (date) (date) (date) (date) (date) (date) (date) (date) (date) (date) (date) (date) (date) (date) (date) (date) (date) (date) (date)
1 ACUÑA , SOPHIA REIGNE DITOL
2 Alforte, Eidelwisse C.
3 ALIMAN , KYLA MAE ABARICIO
4 ALLANIC , CHRISTINE JOYCE SANES
5 Arriesgado, Rowena Abaro
6 Arrogante , Althea Karylle Yabao
7 Bartolata , Krystal Shane Castillo
8 CABUENAS, MARION ELLIS P.
9 CENDAÑA , MA KATRINA CUARESMA
10 Centeno, Sarah Esquivel
11 CRUZ , ANDREA LAGARDE
12 Guile. Quenne Eve B.
13 Gulla, Jenny Rose Flores
14 GUTIERREZ , MA ANGELICA JADLOC
15 Hernandez, Joyen Marie Bareguez
16 Lontoco, Xyrish Angel
17 Mabansay, Shiela Mae Abando
18 PATIGDAS , EDIETHA LUNA
19 PONTEVEDRA , QUENCY JADE ANGCOT
20 Quiambao , Khytte Maigan Ogking
21 Rafaela, Windy Arevalo
22 RANTE , CRISTINE JOY CASTRO
23 ROARING , REGINE -
24 ROLDAN, KAREN D.
25 Romulo , Asriel Tiodocio
26 Sabandal , Christine May Santacera
27 Sajor, Biancca Eloisa C.
28 Talaro , Kate Clarisse Orendain
29 UMALI , RACHELLE MAE ESCUETA
30 VACAL , RACHEL ANN -
31 Victoriano , Pam Rose Lovina

*Consent given Administered by: Noted by:

____________________
______________________ ____________ _____ ____________
Class Adviser Date Grade Level Teacher Date
Form 1 - Classroom Level Annex A1
School-based Weekly Iron Folic Acid (WIFA) Supplementation

Region: _ III Division: ______ CITY OF SAN JOSE DEL MONTE Date: ________________________________ School Year: _____ 2017-2018
School IC: _______________ Name of School: _____ SAPANG PALAY NATIONAL HIGH SCHOOL
Grade Level/Section: 8-MANGOSTEEN No. of Students Enrolled: ___ 57 No. of Female Learners: 31 Address: ________ FATIMA V AREA E

Provided with Irno Folic Acid Supplements

Consent* 1st Round 2nd Round
LRN NAME OF LEARNER July August September January February March Remarks

Y N W1 W2 W3 W4 W1 W2 W3 W4 W1 W2 W3 W4 W1 W2 W3 W4 W1 W2 W3 W4 W1 W2 W3 W4
(date) (date) (date) (date) (date) (date) (date) (date) (date) (date) (date) (date) (date) (date) (date) (date) (date) (date) (date) (date) (date) (date) (date) (date)
1 ALFEREZ , MIKKA CAMBEL
2 ARAÑA , MICAELA MERIBELES
3 Baltomore, Esperanza Querubin
4 BERARA , NANCY CIRILLO

5 CANDRALO , JESSA MARIE REAMBILLO

6 CANLAS, JAYDA VALERIE V.

7 Capara, Reyshel-Ann Barriga

8 DE GUZMAN , KRYSTAL JADE BONDOC

9 De Guzman, Queenzelle Janna S.

10 DELA CRUZ, VANESSA P.
11 Emberga, Ma. Cristina Casas
ENRIQUEZ , JENNEFFER RAVEN
12
BORROMEO
13 FAJARDO , MARIAN CRUZ
14 Ferrer, Krishalyn
15 Gallardo, Trisha Kate Fabrigas
16 JUTIC, ABILENE MAE O.
17 Laguitao, Aliyah Mae De Guzman
18 LAQUE , BERNADETTE CABALLERO
19 Lujera , Jherian Mae Catarungan
20 Lustre, Zaidelle Jane Degracia
21 MATABUENA , KARIZZA BELARMINO
22 Mocorro,Ethel Joy Jatico
23 Morillo, Janna P.
24 Oliveros, Kyla Marie Patilla
25 Pautan, Benice Faith
26 Poblete , Angel Laica Labrague
27 PULGA , CRISTINE JOY REYES
28 Quintela , Angelica May Diza
29 San Luis, Jasmin Rose C.
30 Santos , Richielyn Duhig
31 Torres, Sophia Arabella Morauda

*Consent given Administered by: Noted by:

____________________
______________________ ____________ _____ ____________
Class Adviser Date Grade Level Teacher Date
Form 1 - Classroom Level Annex A1
School-based Weekly Iron Folic Acid (WIFA) Supplementation

Region: _ III Division: ______ CITY OF SAN JOSE DEL MONTE Date: ________________________________ School Year: _____ 2017-2018
School IC: _______________ Name of School: _____ SAPANG PALAY NATIONAL HIGH SCHOOL
Grade Level/Section: 8-PINEAPPLE No. of Students Enrolled: ___ 55 No. of Female Learners: 31 Address: ________ FATIMA V AREA E

Provided with Irno Folic Acid Supplements

Consent* 1st Round 2nd Round
LRN NAME OF LEARNER July August September January February March Remarks

Y N W1 W2 W3 W4 W1 W2 W3 W4 W1 W2 W3 W4 W1 W2 W3 W4 W1 W2 W3 W4 W1 W2 W3 W4
(date) (date) (date) (date) (date) (date) (date) (date) (date) (date) (date) (date) (date) (date) (date) (date) (date) (date) (date) (date) (date) (date) (date) (date)
1 Aguilar , Angela Lacad
2 ANGELES , JENNELYN ERADIEL
3 Ariola, Evette Vergara
4 Artotiles, Kimberly Rusiana
5 Barcos, Princess Ederlyn
6 BASAŇEZ, MARIBEL
7 Berja, Jocelyn R.
8 BINERO, WYONA ALEXIA
9 DAGAMI , CHONA RADIANG
10 DOLINA , LIAN SHANE APRODA
11 DONATO, RIZA NICOLLE L.
12 Elcano, Jasmin A.
13 ELJERA , ALYANNA KARYL GUDIZAN
14 Ellana, Rowena P.
15 JIMENEZ , KRIZHEL FAITH BABAS
16 LARON , MIA SHARMEN EGUIA
17 Lopez, Rhea Christy Mendoza
18 Lucero, Caira Mae
19 MACABANTE , MARIFE SALONGA
20 Naces, Erica Shane Monte Castro
21 Ocado, Katrina Yusi
22 Paiste, Crisanta Mae Sanchez
23 Porras, Erdriann Tengco
24 RODRIGUEZ , EDILYN PESIMO
25 ROMANDIAR , IRISH PINEDA
26 SABALO , ADA KRISNAH CRUZ
27 San Pedro, Princess V.
28 SANTIAGO, JANNAH CHRISHA M.
29 SUELLO , MICHELLE MAMANGON
30 TIONGSON , AIRA MARIE TUYOGON
31 Trilles, Love Marie Antonio

*Consent given Administered by: Noted by:

____________________
______________________ ____________ _____ ____________
Class Adviser Date Grade Level Teacher Date
Form 1 - Classroom Level Annex A1
School-based Weekly Iron Folic Acid (WIFA) Supplementation

Region: _ III Division: ______ CITY OF SAN JOSE DEL MONTE Date: ________________________________ School Year: _____ 2017-2018
School IC: _______________ Name of School: _____ SAPANG PALAY NATIONAL HIGH SCHOOL
Grade Level/Section: 8-TAMARIND No. of Students Enrolled: ___ 59 No. of Female Learners: 36 Address: ________ FATIMA V AREA E

Provided with Irno Folic Acid Supplements

Consent* 1st Round 2nd Round
LRN NAME OF LEARNER July August September January February March Remarks

Y N W1 W2 W3 W4 W1 W2 W3 W4 W1 W2 W3 W4 W1 W2 W3 W4 W1 W2 W3 W4 W1 W2 W3 W4
(date) (date) (date) (date) (date) (date) (date) (date) (date) (date) (date) (date) (date) (date) (date) (date) (date) (date) (date) (date) (date) (date) (date) (date)
1 AFABLE , ANDREA SHANE SARTE
2 Agustin, Jesselle P.
3 ALTICHE , SHAYNE ELYZZA RUBO
4 Antido, Alizza Villas
5 Azucena , Ella Shane Buenconcejo
6 Calipes, Analiza Surigao
7 CALLEJA , MICAELLA ZATA
8 CARVAJAL , KEYSIE -
9 Cerera, Mickaela Joy M.
10 CERICO , HILLARY FERNANDEZ
11 Dela Peňa, Lovelyn Narca
12 Encinares, Alyssa Marie D.
13 Hetio, Julie Ann Donor
14 JANEO, CRIZHA SHANE L.
15 Labuan, Kristelle Kate S.
16 MACAYLAS, MARIAN D.
17 Mallari , Shekinah Mae Ryan Grado

18 MARAVILLA , MARIANNE JOYCE MERCADO

19 Marquez, Alyzza Mae Orsal

20 Mayono, Kaileen Mae Manila
21 MONTEROSO , REGINA GALIAS
22 Mulang, Ruzzel Villanera
23 OCFEMIA, CHASTINE P.
24 Orias, Mariel Eunice Magpale
25 RAMOS , RIZALYN MALINAO
26 REALBA, MARYBETH M.
27 Reyes, Micaella Bondad
28 RIONDA , RODELYN BERMUNDO
29 ROSAL , GENALYN CRUZ
30 Septimo, Hellene Grace Eligio
31 SORIANO , CHEREEDENE CABANERO
32 Tumulak, Nelly Paubsanon
33 URSAL , PAULYN JOY SALAZAR
34 VALINTIN, JORELL MAE B.
35 VILLAMOR , KASSANDRA JOYCE BELVIZ

36 YUAN , NICOLE GENISIS VILLA

*Consent given Administered by: Noted by:

____________________
______________________ ____________ _____ ____________
Class Adviser Date Grade Level Teacher Date
Form 1 - Classroom Level Annex A1
School-based Weekly Iron Folic Acid (WIFA) Supplementation

Region: ______________ III Division: ______ CITY OF SAN JOSE DEL MONTE Date: ________________________________ School Year: ____ 2017-2018
School IC: _______________ Name of School: _____ SAPANG PALAY NATIONAL HIGH SCHOOL
Grade Level/Section: 8-SANTOL No. of Students Enrolled: ___ 57 No. of Female Learners: 31 Address: _______ FATIMA V AREA E

Provided with Irno Folic Acid Supplements

Consent* 1st Round 2nd Round
LRN NAME OF LEARNER July August September January February March Remarks

Y N W1 W2 W3 W4 W1 W2 W3 W4 W1 W2 W3 W4 W1 W2 W3 W4 W1 W2 W3 W4 W1 W2 W3 W4
(date) (date) (date) (date) (date) (date) (date) (date) (date) (date) (date) (date) (date) (date) (date) (date) (date) (date) (date) (date) (date) (date) (date) (date)
1 ABES , ALEXA MAY SINDAYEN
2 ALVARADO , JESSABEL CABRERA
3 Apundar, Rhea Valencia
4 Aquino, Jowela Castañeda
5 ARENAS , RODALYN CORPUZ
6 Batino, Angelica Ras
7 Bondoc, Alyanna Joy Palmes
8 DANIEL , ROSALIE DELA CRUZ
9 Diamsay, Jenny Lyn Ticsay
10 DIONELA , ASHLEY NICOLE YAO
11 Divino, Ernestine
12 DUBA, KATHERINE C
13 FERRER, NICOLE G.
14 GALACGAC , CATHERINE BONADOR
15 Garcia, Angelica Mae -
16 Gitanes, Karl Ann
17 GONZALES , FRANCHEZCA TRIXIE ARDOÑA

18 Honrado, Angel Anne L.

19 ICANG , EMMARY GUINING
20 Lorenzo, Ara Navales
21 MANALO , ANGEL GO
22 Melca, Josah Lara
23 MORAN , BABYLYN SY
24 ORTIZ , KIMBERLI -
25 RANOCO , MAYBELINE SARSIA
26 RIVERA, FAITH G.
27 SALAZAR, EUANNE MURICH
28 Tesado, Angelyka Tilos
29 Tinasa, Catherine Villaflores
30 TINASA, KAREN V.
31 Ventura, Caroline Jane Eulin

*Consent given Administered by: Noted by:

____________________
______________________ ____________ _____ ____________
Class Adviser Date Grade Level Teacher Date
Form 1 - Classroom Level Annex A1
School-based Weekly Iron Folic Acid (WIFA) Supplementation

Region: ______________ III Division: ______ CITY OF SAN JOSE DEL MONTE Date: ________________________________ School Year: ____ 2017-2018
School IC: _______________ Name of School: _____ SAPANG PALAY NATIONAL HIGH SCHOOL
Grade Level/Section: 8-MELON No. of Students Enrolled: ___ 59 No. of Female Learners: 35 Address: _______ FATIMA V AREA E

Provided with Irno Folic Acid Supplements

Consent* 1st Round 2nd Round
LRN NAME OF LEARNER July August September January February March Remarks

Y N W1 W2 W3 W4 W1 W2 W3 W4 W1 W2 W3 W4 W1 W2 W3 W4 W1 W2 W3 W4 W1 W2 W3 W4
(date) (date) (date) (date) (date) (date) (date) (date) (date) (date) (date) (date) (date) (date) (date) (date) (date) (date) (date) (date) (date) (date) (date) (date)
1 Abaricio, Jane Micah Nueva
2 ARTANA , MICHAELA PAAS
3 BAARDE , PRECIOUS MAE COBACHA
4 Bellen, Winona Jean
5 CACAYURAN , ELYZZA ROSSE VERGARA
6 CARDOSA, JEIME B.
7 CARLOS , KAMAE RODAJE
8 CELESTIAL, ANGELICA N.
9 CORDENILLO, ALLYZA ROSE M.
10 Coritana, Liezyl Tabuzo
11 David, Iris Mendoza
12 DELA CRUZ , JASMINE NAVARRA
13 DOMINGO , CRIZA JANE AUSTERO
14 Echevarria, Kyrah Kaye Rebuse
15 EMBELLADO, AILYN M.
16 Estonina, Angel Mae Cabig
17 GALON , RHEALYN COLLANTO
18 JACOBA , JHONABELL IGNACIO
19 LABITAN , JUSTINE SADULLO
20 LANDRITO , JA IRISH CLAVINES
21 LU, MA. THERESA D.
22 Manota, Lheca Mee Ticong
23 MENDANIO , ALEH ROSE VILLERO
24 ORIAS , JENYLYN DEANO
25 Paredes, Divine S.
26 PEÑA , JENNILYN DELMUNDO
27 Rosales, Myrishia San Felipe
28 Samodio, Mary Eunice Dalit
29 Sampilo, Jeazelle Alcanzare
30 Sonaya, Mary Grace Matutina
31 Susana, Danica T.
32 TOLIPAS , ROMELYN CARIAS
33 Varona, Mary Anne Villanueva
34 VILLAFLORES , JOANA LLERMA
35 VILLANUEVA, YANA ALTHEA

*Consent given Administered by: Noted by:

____________________
______________________ ____________ _____ ____________
Class Adviser Date Grade Level Teacher Date
Form 1 - Classroom Level Annex A1
School-based Weekly Iron Folic Acid (WIFA) Supplementation

Region: ______________ III Division: ______ CITY OF SAN JOSE DEL MONTE Date: ________________________________ School Year: ____ 2017-2018
School IC: _______________ Name of School: _____ SAPANG PALAY NATIONAL HIGH SCHOOL
Grade Level/Section: 8-ATIS No. of Students Enrolled: ___ 65 No. of Female Learners: 35 Address: _______ FATIMA V AREA E

Provided with Irno Folic Acid Supplements

Consent* 1st Round 2nd Round
LRN NAME OF LEARNER July August September January February March Remarks

Y N W1 W2 W3 W4 W1 W2 W3 W4 W1 W2 W3 W4 W1 W2 W3 W4 W1 W2 W3 W4 W1 W2 W3 W4
(date) (date) (date) (date) (date) (date) (date) (date) (date) (date) (date) (date) (date) (date) (date) (date) (date) (date) (date) (date) (date) (date) (date) (date)
1 ACAL , JOANA LORAINE MANLANGIT
2 Abubakar, Rechel
3 Angelo, Denise Anne
4 APOSTOL , MHER JADE DELOS REYES
5 Bautista , Coleen Calindas
6 BLANES , DIANE JULIA -
7 CABUGOS , SHERYLL PILAPIL
8 CONDENO , JANNA BELLE BUAT
9 Corpuz, Laila Joharha
10 DA-A , JUSTINE NAVARRO
11 DELA CRUZ , RAILAH YARANON
12 ECAP , SUNSHINE JUDE SALVEDIA
13 ESPAÑOLA , SOPHIA MAE JUATAS
14 FABROS , RONALYN -
15 FERNANDEZ, MICHELLE D.
16 FLORES , MELISSA SABEROLA

17 GALOS , PRINCES ANN MARCEL MANABAT

18 GAVIOLA , KC FRANCISCO
19 JARA , VANESSA LABRADOR
20 JOSON , HERSHEY MAY GUTIERREZ
21 Lama, Juliana
22 Mendoza, Rea Ann Gabanei
23 Mesias, Zybhel Anne
24 Orbista, Camiel T.
25 REAS , REGINE GONZALES
26 REGERO , CHRIS CHAIN FERNANDEZ
27 Santiago, Francine Joy Nicdao
28 Soria, Kylin Ochoa
29 TATOY , DANIELLA MAE CURSO
30 TRIAS , JEILYN MARABE

*Consent given Administered by: Noted by:

____________________
______________________ ____________ _____ ____________
Class Adviser Date Grade Level Teacher Date
Form 1 - Classroom Level Annex A1
School-based Weekly Iron Folic Acid (WIFA) Supplementation

Region: ______________ III Division: ______ CITY OF SAN JOSE DEL MONTE Date: ________________________________ School Year: ____ 2017-2018
School IC: _______________ Name of School: _____ SAPANG PALAY NATIONAL HIGH SCHOOL
Grade Level/Section: 8-BANANA No. of Students Enrolled: ___ 66 No. of Female Learners: 30 Address: _______ FATIMA V AREA E

Provided with Irno Folic Acid Supplements

Consent* 1st Round 2nd Round
LRN NAME OF LEARNER July August September January February March Remarks

Y N W1 W2 W3 W4 W1 W2 W3 W4 W1 W2 W3 W4 W1 W2 W3 W4 W1 W2 W3 W4 W1 W2 W3 W4
(date) (date) (date) (date) (date) (date) (date) (date) (date) (date) (date) (date) (date) (date) (date) (date) (date) (date) (date) (date) (date) (date) (date) (date)
1 ACQUIAT , ALTHEA JEAN GUIWAN
2 Alegando, Judelyn Remazo
3 Aranjuez, Charina N.
4 AVENDAÑO , MONICA ANN DAYAPAN
5 BACARESAS, JULIANA F.
6 BALDONADO, CHARLOTTE M.
7 CORDERO , RACHELLE ANN OLIVA
8 Dioneda, Irish Mae Belen
9 ENCINARES, ALICIA MARIE D.
10 Enrera, Lorena Baronia
11 FALCON, ALLYSON R.
12 Laron, Justine Eguia
13 Llander, Juzz DL.
14 LOY-A , ME GRACE VERONICA -
15 Luha, Rexy Shekinah Morales
16 Malate, Nicole Angel
17 PADILLA , ALDRILYN CAPA
18 Paule, Mariane DC.
19 QUIRANTE , FERLYN RAMOS
20 Ramos, Alexcis Tolentino
21 RIGOR , ANN MARGARET ELIZAGA
22 Roca, Danica Budhi
23 Rodaje, Jana Partoza
24 Rosario, Risa Abas
25 SARITO, HANNILYN A.
26 SUMEGUIN, JUNIE ROSE M.
27 Tallo, Rhenadin Campomanes
28 Tijedor, Cristine Joy Onsik
29 VALMERA , DAISYREN ROSE MANCIO
30 VELARDE , KYLA MUNGCAL
31 VILLANUEVA , LOVELYN VICTORIA

*Consent given Administered by: Noted by:

____________________
______________________ ____________ _____ ____________
Class Adviser Date Grade Level Teacher Date
Form 1 - Classroom Level Annex A1
School-based Weekly Iron Folic Acid (WIFA) Supplementation

Region: ______________ III Division: ______ CITY OF SAN JOSE DEL MONTE Date: ________________________________ School Year: ____ 2017-2018
School IC: _______________ Name of School: _____ SAPANG PALAY NATIONAL HIGH SCHOOL
Grade Level/Section: 8-CASHEW No. of Students Enrolled: ___ 62 No. of Female Learners: 30 Address: _______ FATIMA V AREA E

Provided with Irno Folic Acid Supplements

Consent* 1st Round 2nd Round
LRN NAME OF LEARNER July August September January February March Remarks

Y N W1 W2 W3 W4 W1 W2 W3 W4 W1 W2 W3 W4 W1 W2 W3 W4 W1 W2 W3 W4 W1 W2 W3 W4
(date) (date) (date) (date) (date) (date) (date) (date) (date) (date) (date) (date) (date) (date) (date) (date) (date) (date) (date) (date) (date) (date) (date) (date)
1 ARCE, CATHY A.
2 BACONG , DENNYZ KYLE MAGAYON
3 BALISALISA, MARIANNE P.
4 Belarmino, Ariane Baclas
5 Benzon, Jamille Olaybar
6 Cecogo, Jennifer Marie Bautista
7 CERENIO, MA. ALEXANDRA C.
8 DE MESA , KAREN KAYE RIOS
9 Diamante, Maricar Perez
10 ESQUIVEL, LYKA ANDREA j.
11 Facundo, Alyssa Malubay
12 FERRER , JOANN-CKY AQUINO
13 GARONIA , CHARLOTTE JANE BOTE
14 GERME, JODY MAE D.
15 Granada, Marijo V.
16 Inoncillo, Airish J.
17 MADEJA , LEA MAE SARCILLA
18 MANANGUIT, JOANA MARIE T.
19 Mariano, Sherilyn Gera
20 Molina, Jonas Danielle
21 Oleja, Romielyn Abad
22 PASCUAL , JULIA MARIE CORPUZ
23 Peregrino, Maevelyn Joy
24 QUILAP-QUILAP, JIN FAE S.
25 SABONG, POLLAH MARIN S.
26 SAN JUAN , EUNICE RAMIREZ
27 Sytamco, Ma. Teresa Razon
28 TERNIDA, JADE L.
29 Tibay, Catherine Joy Masbang
30 Torrenueva, Leogin E.

*Consent given Administered by: Noted by:

____________________
______________________ ____________ _____ ____________
Class Adviser Date Grade Level Teacher Date
Form 1 - Classroom Level Annex A1
School-based Weekly Iron Folic Acid (WIFA) Supplementation

Region: ______________ III Division: ______ CITY OF SAN JOSE DEL MONTE Date: ________________________________ School Year: ____ 2017-2018
School IC: _______________ Name of School: _____ SAPANG PALAY NATIONAL HIGH SCHOOL
Grade Level/Section: 8-PAPAYA No. of Students Enrolled: ___ 65 No. of Female Learners: 26 Address: _______ FATIMA V AREA E

Provided with Irno Folic Acid Supplements

Consent* 1st Round 2nd Round
LRN NAME OF LEARNER July August September January February March Remarks

Y N W1 W2 W3 W4 W1 W2 W3 W4 W1 W2 W3 W4 W1 W2 W3 W4 W1 W2 W3 W4 W1 W2 W3 W4
(date) (date) (date) (date) (date) (date) (date) (date) (date) (date) (date) (date) (date) (date) (date) (date) (date) (date) (date) (date) (date) (date) (date) (date)
1 ASTORGA , WENMA ALCOSEBA
2 ASUNCION , MARIAN -
3 Avila, Fairy Ann P.
4 Baclayo, Mikee Marie M.
5 Barcelona, Alex Sandra
6 BUNIEL , ANGEL GACMATAN

7 CALDERON , JOIELINE EUNICE KATE PARCIA

8 DE LUNA , JHUSTIN MERENCILLA

9 LLANTOS , MARIA KYLA SANORA
10 MACABITAS, JEAN GLERICKA L.
11 MANGAHAS , JOEY MAE AREVALO
12 MARANGIT , HANNIAH PITI-ILAN
13 MORENO, CHRISTINE JADE B.
14 NABUAB , REMELYN MALE
15 NAUL , RAIZA MARIE FLORES
16 NUEVA , JANE LEGASPI
17 OCHOA , JULIANA FLORES

18 PADILLA , ANGELA JOYCE ANNE GONZALES

19 Quesea, Riasel D.
20 ROXAS , KRISTEL JOYCE FERNANDEZ
21 SELDA , ALDRIZZA LOPEZ
22 SOLOMON , JENNELYN TORRES
23 SONAYA , JASMINE ROSE GALLEGO
24 SUNGA , BERNA MARIE FERMIN
25 TURLA , VIA RAMOS
26 VILLASQUEZ , ALYANA DADO

*Consent given Administered by: Noted by:

____________________
______________________ ____________ _____ ____________
Class Adviser Date Grade Level Teacher Date
Form 1 - Classroom Level Annex A1
School-based Weekly Iron Folic Acid (WIFA) Supplementation

Region: ______________ III Division: ______ CITY OF SAN JOSE DEL MONTE Date: ________________________________ School Year: ____ 2017-2018
School IC: _______________ Name of School: _____ SAPANG PALAY NATIONAL HIGH SCHOOL
Grade Level/Section: 8-RAMBUTAN No. of Students Enrolled: ___ 65 No. of Female Learners: 26 Address: _______ FATIMA V AREA E

Provided with Irno Folic Acid Supplements

Consent* 1st Round 2nd Round
LRN NAME OF LEARNER July August September January February March Remarks

Y N W1 W2 W3 W4 W1 W2 W3 W4 W1 W2 W3 W4 W1 W2 W3 W4 W1 W2 W3 W4 W1 W2 W3 W4
(date) (date) (date) (date) (date) (date) (date) (date) (date) (date) (date) (date) (date) (date) (date) (date) (date) (date) (date) (date) (date) (date) (date) (date)
1 Abarra, Joana Marie Plana
2 ALAURIN, BERNADETH M.
3 Bardaje, Antonette C.
4 Canoy, Alliza Garcia
5 CAPISTRANO , RHEALY JOY BENITEZ
6 Corro, Angelene Pidot
7 Credo, Jonie Ross Ann Mazo
8 Daño, Maui Manucay
9 Dimaculangan, Claire Vedua
10 Fernando, Renelyn G.
11 Ferol, Marijo C.
12 Francisco, Aluna Joy Carmen
13 GALACGAC, CLAIRE V.
14 Interior, Evangeline S.
15 Montes, Marinel
16 PERALTA, ANGELINE G.
17 RAMOS , SHAILA MARIE LAZARTE
18 RELATA, EDDILYN G
19 Rentasida, Ainna Marie Robiato
20 San Jose, Carla Ashly Cabal
21 Santos, Arrisa Gavina
22 SIMBULAN, MARIANE ELENIE D.
23 Tobias, Pearlyn Apresto
24 Tuliao, Ruth Doligol
25 Vibar, Ma. Shaiena Jane Rastrullo
26 Villacampa, Iary Mellene Galvez

*Consent given Administered by: Noted by:

____________________
______________________ ____________ _____ ____________
Class Adviser Date Grade Level Teacher Date
Form 1 - Classroom Level Annex A1
School-based Weekly Iron Folic Acid (WIFA) Supplementation

Region: ______________ III Division: ______ CITY OF SAN JOSE DEL MONTE Date: ________________________________ School Year: ____ 2017-2018
School IC: _______________ Name of School: _____ SAPANG PALAY NATIONAL HIGH SCHOOL
Grade Level/Section: 8-DURIAN No. of Students Enrolled: ___ 67 No. of Female Learners: 25 Address: _______ FATIMA V AREA E

Provided with Irno Folic Acid Supplements

Consent* 1st Round 2nd Round
LRN NAME OF LEARNER July August September January February March Remarks

Y N W1 W2 W3 W4 W1 W2 W3 W4 W1 W2 W3 W4 W1 W2 W3 W4 W1 W2 W3 W4 W1 W2 W3 W4
(date) (date) (date) (date) (date) (date) (date) (date) (date) (date) (date) (date) (date) (date) (date) (date) (date) (date) (date) (date) (date) (date) (date) (date)
1 AGUILOS , JENNYLYN LIBRELLA
2 ANDAYA , SHEREL TEROL
3 Aňo, Jocelle Marie A
4 BACUNGAN, ALLIAH AMBHER A.
5 Balingit, Mary Grace C.
6 BURAGAY , HAZEL MAE BAWA-AN
7 Davis, Elnarr M.
8 Daz, Kassandra B.
9 GALLA , JASMIN CARIAGA
10 LANZAR , DUDELYN GEROCA
11 LOPICIO , HONEY BELL FRANCISCO
12 LUCHING, FERIEROSE ANN B.
13 MACAWILI, RAPUNZEL B.
14 MARTINEZ , MARY GRACE DELITO
15 MONTOYA , ANGELINE REYES
16 Pamela, Anne Fiel
17 QUITORAS , MARIEL CANONEO
18 RAGA , JELICA OSO
19 Remegio, Reina Mae C.
20 Rogon, Mary Claine A.
21 TABUQUILDE , HIYASMINE RODRIGUEZ
22 TENORIO, RAZEL JOY C.
23 Tina-an, Juvy Joy M.
24 VALDEZ , JENIE HEART PUNTAS
25 Debalucos, Edmer Lyn V.

*Consent given Administered by: Noted by:

____________________
______________________ ____________ _____ ____________
Class Adviser Date Grade Level Teacher Date
Form 1 - Classroom Level Annex A1
School-based Weekly Iron Folic Acid (WIFA) Supplementation

Region: ______________ III Division: ______ CITY OF SAN JOSE DEL MONTE Date: ________________________________ School Year: ____ 2017-2018
School IC: _______________ Name of School: _____ SAPANG PALAY NATIONAL HIGH SCHOOL
Grade Level/Section: 8-JACKFRUIT No. of Students Enrolled: ___ 71 No. of Female Learners: 23 Address: _______ FATIMA V AREA E

Provided with Irno Folic Acid Supplements

Consent* 1st Round 2nd Round
LRN NAME OF LEARNER July August September January February March Remarks

Y N W1 W2 W3 W4 W1 W2 W3 W4 W1 W2 W3 W4 W1 W2 W3 W4 W1 W2 W3 W4 W1 W2 W3 W4
(date) (date) (date) (date) (date) (date) (date) (date) (date) (date) (date) (date) (date) (date) (date) (date) (date) (date) (date) (date) (date) (date) (date) (date)
1 Afable, Cherry Mae Guibao
2 Abuel, Hannilyn S.
3 AQUINO , EILAIZA MAY PAMERO
4 BANGALISAN, ANJANETTE R.
5 BARRACA, JEWEL A.
6 Camello, Honey Grace Torquator
7 Cereno, Maria Arcelyn Baby Rose V.
8 CRUZ , JONAVEL NULLAS
9 DAGONDON , TRICIA GAIL -
10 Galicia, Judelyn S.
11 Gumabon, Joveellyn Anne Diaz
12 Gura, Jasmine T.
13 HONA , JANE KYLEN MENCHERO
14 Mapanao, Elioza Atijera
15 Mateo, Diana Brynz D.
16 Modrigo, Jasmine Joy H.
17 Namata, Rose Ann Ongan
18 OLIVEROS, MARY GRACE
19 Ongan, Christine Marasigan
20 Pura, Micah Ella Villaluna
21 Sia, Johanna Marie
22 Torres, Shaira Nicole Placido
23 Uchi, Viola Ann Omayan

*Consent given Administered by: Noted by:

____________________
______________________ ____________ _____ ____________
Class Adviser Date Grade Level Teacher Date
Form 1 - Classroom Level Annex A1
School-based Weekly Iron Folic Acid (WIFA) Supplementation

Region: ______________ III Division: ______ CITY OF SAN JOSE DEL MONTE Date: ________________________________ School Year: ____ 2017-2018
School IC: _______________ Name of School: _____ SAPANG PALAY NATIONAL HIGH SCHOOL
Grade Level/Section: 8-DUHAT No. of Students Enrolled: ___ 65 No. of Female Learners: 29 Address: _______ FATIMA V AREA E

Provided with Irno Folic Acid Supplements

Consent* 1st Round 2nd Round
LRN NAME OF LEARNER July August September January February March Remarks

Y N W1 W2 W3 W4 W1 W2 W3 W4 W1 W2 W3 W4 W1 W2 W3 W4 W1 W2 W3 W4 W1 W2 W3 W4
(date) (date) (date) (date) (date) (date) (date) (date) (date) (date) (date) (date) (date) (date) (date) (date) (date) (date) (date) (date) (date) (date) (date) (date)
1 Aboga, Mariel Anjela Mayo
2 BAJARIAS , CHRISTINE JUNSAY
3 Bautista, Kristel Joy
4 BOCBOC , LEDIKAY ANOCOP
5 BOTE , MARINELL DIAZ
6 CANO, ROANNE ANGEL L.
7 Celin, Norlyn Joy O.
8 Clemente, Alexandra Nicole Cailes
9 Crisostomo, Miles Oliva
10 Dante, Reyzelle P.
11 DELA CRUZ, ANGELICA DL.
12 DELA PEÑA , LAILA JANE SANORA
13 Francisco, Russel M.
14 Lagrada, Jeraldine Barantes
15 LEGASPI, MARIENER SP.
16 Lingatong, Beinvinida M.
17 LOLARGA , JENINE ROSE SUAZON
18 Mallari, Ashly Jhade Gerardo

19 ORBISTA , ALLIAH BENNETTE CORDERO

20 Puya, Dara G.
21 SALES , PAULA DE LEON
22 Samonte, Choikey M.
23 SAN GASPAR, ASTRID CAROLINA R.
24 SARITO , SHERLIE -
25 TAGAPAN , RICA ESPEÑO
26 Tirol, Carlen Jane N.
27 Torres, Ma. Alicia F.
28 VILLABLANCA , DIANA LHEY ESPAÑOLA
29 Villanueva, Rhea Mae M.

*Consent given Administered by: Noted by:

____________________
______________________ ____________ _____ ____________
Class Adviser Date Grade Level Teacher Date
Form 1 - Classroom Level Annex A1
School-based Weekly Iron Folic Acid (WIFA) Supplementation

Region: ______________ III Division: ______ CITY OF SAN JOSE DEL MONTE Date: ________________________________ School Year: ____ 2017-2018
School IC: _______________ Name of School: _____ SAPANG PALAY NATIONAL HIGH SCHOOL
Grade Level/Section: 8-LEMON No. of Students Enrolled: ___ 69 No. of Female Learners: 27 Address: _______ FATIMA V AREA E

Provided with Irno Folic Acid Supplements

Consent* 1st Round 2nd Round
LRN NAME OF LEARNER July August September January February March Remarks

Y N W1 W2 W3 W4 W1 W2 W3 W4 W1 W2 W3 W4 W1 W2 W3 W4 W1 W2 W3 W4 W1 W2 W3 W4
(date) (date) (date) (date) (date) (date) (date) (date) (date) (date) (date) (date) (date) (date) (date) (date) (date) (date) (date) (date) (date) (date) (date) (date)
1 ABARRACOSO , NIZA MAY LACABA
2 Aquino, Rosalina Mauro
3 Batoy, Carmi Malinao
4 Belarmino, Corrine Ann Mae Divino
5 BORLADO, ROMELYN G.
6 Fajardo, Nathalie Joy
7 GASQUE, EMIELYN T.
8 Gonzalo, Arnee Joy
9 HERRERA -, MARICAR AUSTRIA
10 Ingco, Rechelle S.
11 Inventado, Angela Grace M.
12 Isip, Niccaela N.
13 LASAY, ERICA L.
14 LEE, JONALYN M.
15 Macaranas, Elina B.
16 MAGAN, CLAINA ROSE E.
17 MALINAY, JANINE L.
18 MAMBURAM , JOANNA FE BASCO
19 MATALANG , DANIELA DELOS SANTOS
20 NIERRAS, ROSE ANN D.
21 Pascua, Kiah Denise G.
22 Queen, Aica Lleana
23 SAN PEDRO, NICOLE
24 SILVANO , MARLYN KATE IGNACIO
25 Vedrero, Kimberly S.
26 VELASCO , JADE ASHLEY NAONG
27 VICTORIANO, AIRALYN D.

*Consent given Administered by: Noted by:

____________________
______________________ ____________ _____ ____________
Class Adviser Date Grade Level Teacher Date
Form 1 - Classroom Level Annex A1
School-based Weekly Iron Folic Acid (WIFA) Supplementation

Region: ______________ III Division: ______ CITY OF SAN JOSE DEL MONTE Date: ________________________________ School Year: ____ 2017-2018
School IC: _______________ Name of School: _____ SAPANG PALAY NATIONAL HIGH SCHOOL
Grade Level/Section: 8-ORANGE No. of Students Enrolled: ___ 66 No. of Female Learners: 26 Address: _______ FATIMA V AREA E

Provided with Irno Folic Acid Supplements

Consent* 1st Round 2nd Round
LRN NAME OF LEARNER July August September January February March Remarks

Y N W1 W2 W3 W4 W1 W2 W3 W4 W1 W2 W3 W4 W1 W2 W3 W4 W1 W2 W3 W4 W1 W2 W3 W4
(date) (date) (date) (date) (date) (date) (date) (date) (date) (date) (date) (date) (date) (date) (date) (date) (date) (date) (date) (date) (date) (date) (date) (date)
1 ARCE, ELLA A.
2 Beberino, Jhoveline Niegas
3 Brocales, Jose Estavillo
4 Cano, Rio Nel J.
5 CANTOS , MARILOU COROLLO
6 Cantos, Kaye Ann C.
7 Del Pilar, Angel
8 DUQUE, LEARWIN P.
9 Felix, Patricia S.
10 Gallardo, Rochelle S.
11 Garrido, LJ D.
12 Legaspi, Joy Ann B.
13 Lim, Cherrylyn Mendoza
14 MAGALLANES, AESHA CAYTE
15 MANALO, REINA G.
16 NOVIO , THERESE ANN ESTOPACE
17 Peňaflor, Jonalyn M.
18 PISICO, LOVELY V.
19 Pogenio, Michaela C.
20 Retona, Jennifer P.
21 SEVILLENO , MILANOR BEBERENO
22 SIM , SHAIRA MAE MARGA
23 Sunga, Bernalie Fermin
24 Tejada, Ma. Eddielyn Sarboda
25 Turla, Richer Pacificar
26 VILLEGAS, ANALYN A.

*Consent given Administered by: Noted by:

____________________
______________________ ____________ _____ ____________
Class Adviser Date Grade Level Teacher Date
Form 1 - Classroom Level Annex A1
School-based Weekly Iron Folic Acid (WIFA) Supplementation

Region: ______________ III Division: ______ CITY OF SAN JOSE DEL MONTE Date: ________________________________ School Year: ____ 2017-2018
School IC: _______________ Name of School: _____ SAPANG PALAY NATIONAL HIGH SCHOOL
Grade Level/Section: 8-ANONAS No. of Students Enrolled: ___ 65 No. of Female Learners: 23 Address: _______ FATIMA V AREA E

Provided with Irno Folic Acid Supplements

Consent* 1st Round 2nd Round
LRN NAME OF LEARNER July August September January February March Remarks

Y N W1 W2 W3 W4 W1 W2 W3 W4 W1 W2 W3 W4 W1 W2 W3 W4 W1 W2 W3 W4 W1 W2 W3 W4
(date) (date) (date) (date) (date) (date) (date) (date) (date) (date) (date) (date) (date) (date) (date) (date) (date) (date) (date) (date) (date) (date) (date) (date)
1 Abillar, Leonie Bergonio
2 Antonio, Jonalene A
3 ARABA , ISABEL BANGILAN
4 ARNAIZ , JUDY ANNE AMBAIC
5 Arrogante, Jhemilyn P.
6 ASPILE, PRINCESS MONAMI M.
7 Avila, Crystalene
8 BARAQUIA , JIEZEL MARIE OCAMPO
9 Bayaga, Pamela Nicole I.
10 Bergonio, Richell S.
11 Braulio, Reshell Ann Murphy
12 Canales, Rhea Claresse
13 Condolon, Arliz Gonzaga
14 DAŇAS, ANANECOL P.
15 Daz, Erika B.
16 Maglaqui, Jomaica Aviner
17 MANALANG , KRISTINE -
18 Merquillo, Ronalyn Anne J.
19 PADURA , JUSTINA BERMEJO
20 Sunga, Bernaize Fermin
21 Tirol, Katherin Navea
22 Vejerano, Patria Janine A
23 VELASCO , NIXIE CELESTINO

*Consent given Administered by: Noted by:

____________________
______________________ ____________ _____ ____________
Class Adviser Date Grade Level Teacher Date
Form 1 - Classroom Level Annex A1
School-based Weekly Iron Folic Acid (WIFA) Supplementation

Region: ______________ III Division: ______ CITY OF SAN JOSE DEL MONTE Date: ________________________________ School Year: ____ 2017-2018
School IC: _______________ Name of School: _____ SAPANG PALAY NATIONAL HIGH SCHOOL
Grade Level/Section: 8-POMELO No. of Students Enrolled: ___ 70 No. of Female Learners: 23 Address: _______ FATIMA V AREA E

Provided with Irno Folic Acid Supplements

Consent* 1st Round 2nd Round
LRN NAME OF LEARNER July August September January February March Remarks

Y N W1 W2 W3 W4 W1 W2 W3 W4 W1 W2 W3 W4 W1 W2 W3 W4 W1 W2 W3 W4 W1 W2 W3 W4
(date) (date) (date) (date) (date) (date) (date) (date) (date) (date) (date) (date) (date) (date) (date) (date) (date) (date) (date) (date) (date) (date) (date) (date)

1 ASIS, KIMBERLIE C. - fr. duhat

2 Balbuena, Jenefer A.
3 BARRIOS, RIEDEN FATE fr. Papaya
4 Batola, Melissa S.
5 Bermas, Rica Faye N.
6 Bernales, Kyla Camille
7 Bocal, Klyn Abegail
8 Bongayan, Norelyn B.
9 Corpuz, Monica
10 Dela Bajan, Yenyen P.
11 Eugenio, Mayvelyn
12 Herosa, Aleina Nichole M.
13 Inabangan, Keith G.
14 Keyser, Cate Arwen Jelaiza G.
15 Llaguno, Ellaiza M.
16 Magno, Jieneth
17 Magos, Judy Ann Q.
18 Miguel, Cherrilyn S.
19 Paycana, Dessirry R.
20 Rosal, Roselyn E.
21 Toledo, Nicole D.
22 Trinidad, Maureen
23 Ragua, Alley Zandra

*Consent given Administered by: Noted by:

____________________
______________________ ____________ _____ ____________
Class Adviser Date Grade Level Teacher Date
Form 1 - Classroom Level Annex A1
School-based Weekly Iron Folic Acid (WIFA) Supplementation

Region: ______________ III Division: ______ CITY OF SAN JOSE DEL MONTE Date: ________________________________ School Year: ____ 2017-2018
School IC: _______________ Name of School: _____ SAPANG PALAY NATIONAL HIGH SCHOOL
Grade Level/Section: 8-TOLENTINO No. of Students Enrolled: ___ 39 No. of Female Learners: 31 Address: _______ FATIMA V AREA E

Provided with Irno Folic Acid Supplements

Consent* 1st Round 2nd Round
LRN NAME OF LEARNER July August September January February March Remarks

Y N W1 W2 W3 W4 W1 W2 W3 W4 W1 W2 W3 W4 W1 W2 W3 W4 W1 W2 W3 W4 W1 W2 W3 W4
(date) (date) (date) (date) (date) (date) (date) (date) (date) (date) (date) (date) (date) (date) (date) (date) (date) (date) (date) (date) (date) (date) (date) (date)
1 Aragon, Pamela C.
2 Bacason, Maricor D.
3 Balala, Gelie Ann Q.
4 Balubar, Rica Mae R.
5 Bognot, Romghilyne D.
6 Bulan, Patricia E.
7 Cabales, Andrea Gail S.
8 Cabotaje, Louise Annuelle S.
9 Caparas, Jade Anne M.
10 Castillo, Althea Mae B.
11 Conejos, Pia May D.
12 Cruz, Christina Elisha S.
13 Dela Cruz, Kayzen Joie V.
14 Dipon, Francheska Sofia T.
15 Duque, Louwella W.
16 Francisco, Kyla P.
17 Genieto, Cheslen Marie E.
18 Gonzales, Maureen F.
19 Llegue, Elaine Jane A.
20 Lontoco, Fameya A.
21 Lumontad, Aikaliya D.
22 Mambing, Mikylle Zara T.
23 Neri, Yesha Karel L.
24 Pajunastan, Rica Jane
25 Pelimer, Janine F.
26 Pineda, Eden Marie D.
27 Quinio, Khate Joey E.
28 Sarmiento, Jazz Maureen R.
29 Suzuki, Nana A.
30 Wacan, Maureen M.
31 Yabes, Zea Francesca D.

*Consent given Administered by: Noted by:

____________________
______________________ ____________ _____ ____________
Class Adviser Date Grade Level Teacher Date
Form 1 - Classroom Level Annex A1
School-based Weekly Iron Folic Acid (WIFA) Supplementation

Region: ______________ III Division: ______ CITY OF SAN JOSE DEL MONTE Date: ________________________________ School Year: ____ 2017-2018
School IC: _______________ Name of School: _____ SAPANG PALAY NATIONAL HIGH SCHOOL
Grade Level/Section: 8-MANANSALA No. of Students Enrolled: ___ 45 No. of Female Learners: 25 Address: _______ FATIMA V AREA E

Provided with Irno Folic Acid Supplements

Consent* 1st Round 2nd Round
LRN NAME OF LEARNER July August September January February March Remarks

Y N W1 W2 W3 W4 W1 W2 W3 W4 W1 W2 W3 W4 W1 W2 W3 W4 W1 W2 W3 W4 W1 W2 W3 W4
(date) (date) (date) (date) (date) (date) (date) (date) (date) (date) (date) (date) (date) (date) (date) (date) (date) (date) (date) (date) (date) (date) (date) (date)
1 ALVENDIA, Katryne Nathalie C.
2 Arnaiz, Jerica Mae P.
3 Baruel, Anchelle S.
4 Bengwayan, Rio Jasmin R.
5 Bondoc, Leynard Jane T.
6 Borlongan, Ma.Margarette P.
7 Cabacang, Christessa Mae G.
8 Cabugayan, Janelle Paige D.
9 Camacho, Janise Anne T.
10 Cedenio, Yasmien P.
11 Cordero, Aubrey A.
12 Cortes, Marrielle P.
13 De Leon, Caszandra Keith G.
14 Dilla, Angela
15 Francisco, Gian
16 Garin, Marielle C.
17 Lagman, Cieri Vi C.
18 Mendaro, Franceska Louisse O.
19 Orlanda, Queen Ann B.
20 Padayao, Angel Grace M.
21 Punzal, Jeri Agatha Margaurithe G.
22 Quitain, Marexs Lengels
23 Reblando, Eya Kayte C.
24 Surio, Shaireez Joy T.
25 Valdez, Airish T.

*Consent given Administered by: Noted by:

____________________
______________________ ____________ _____ ____________
Class Adviser Date Grade Level Teacher Date
Form 1 - Classroom Level Annex A1
School-based Weekly Iron Folic Acid (WIFA) Supplementation

Region: ______________ III Division: ______ CITY OF SAN JOSE DEL MONTE Date: ________________________________ School Year: ____ 2017-2018
School IC: _______________ Name of School: _____ SAPANG PALAY NATIONAL HIGH SCHOOL
Grade Level/Section: 8-FRANCISCO No. of Students Enrolled: ___ 38 No. of Female Learners: 26 Address: _______ FATIMA V AREA E

Provided with Irno Folic Acid Supplements

Consent* 1st Round 2nd Round
LRN NAME OF LEARNER July August September January February March Remarks

Y N W1 W2 W3 W4 W1 W2 W3 W4 W1 W2 W3 W4 W1 W2 W3 W4 W1 W2 W3 W4 W1 W2 W3 W4
(date) (date) (date) (date) (date) (date) (date) (date) (date) (date) (date) (date) (date) (date) (date) (date) (date) (date) (date) (date) (date) (date) (date) (date)
1 Amazon, Ronaliza S.
2 Beltran, Remy Rose DC.
3 Berlanas, Jannah N.
4 Borbon, Genesis Amor M.
5 Breganza, Alexandra R.
6 Brillo, Marilyn R.
7 Catacutan, Sophia M.
8 De Leon, Patricia A.
9 Dela Cruz, Atasha Mae M.
10 Diocson, Theresa
11 Escaner, Jyra Shael L.
12 Escleto, Maraiza Eurizze G.
13 Gordo, Irish Ann B.
14 Gutierrez, Julianna S.
15 Hidalgo, Julia Jeanine B.
16 Jori, Clarissa M.
17 Libante, Alyssa
18 Luis, Barry Hope V.
19 Martinez, Viah Christine V.
20 Merca, Marielou C.
21 Mercene, Bernadette M.
22 Navales, Ma.Flordeliza J.
23 Pacheco, Naomi Shemaiah T.
24 Reyes, Rizel
25 San Diego, Angel B.
26 Taylan, Rishi Ancien R.

*Consent given Administered by: Noted by:

____________________
______________________ ____________ _____ ____________
Class Adviser Date Grade Level Teacher Date
Form 1 - Classroom Level Annex A1
School-based Weekly Iron Folic Acid (WIFA) Supplementation

Region: ______________ III Division: ______ CITY OF SAN JOSE DEL MONTE Date: ________________________________ School Year: ____ 2017-2018
School IC: _______________ Name of School: _____ SAPANG PALAY NATIONAL HIGH SCHOOL
Grade Level/Section: 8-AMORSOLO No. of Students Enrolled: ___ 38 No. of Female Learners: 33 Address: _______ FATIMA V AREA E

Provided with Irno Folic Acid Supplements

Consent* 1st Round 2nd Round
LRN NAME OF LEARNER July August September January February March Remarks

Y N W1 W2 W3 W4 W1 W2 W3 W4 W1 W2 W3 W4 W1 W2 W3 W4 W1 W2 W3 W4 W1 W2 W3 W4
(date) (date) (date) (date) (date) (date) (date) (date) (date) (date) (date) (date) (date) (date) (date) (date) (date) (date) (date) (date) (date) (date) (date) (date)
1 Arguelles, Kyla Mae S.
2 Aruta, Jingky Lou M.
3 Bartolome, Mary Jessaleen
4 Calipus, Dzcelyn A.
5 Conde, Aaliyah Mae T.
6 Constantino, Alicia Kate P.
7 Cristobal, Shandalle Ann L.
8 Escolin, Erlin Jane B.
9 Flaminiano, Jocelyn D.
10 Gonzaga, Reigne
11 Jarumay, Julie Ann D.
12 Labador, Moises Julielyn D.
13 Labandrea, Sohpia Riomer O.
14 Manuel, Lyka Jade C.
15 Martinez, Heart Kathleen T.
16 Masangkay, Roselyn Z.
17 Musni, Sophia Jade M.
18 Natividad, Atazha Kylieh O.
19 Pamatian, Gerry Lyn B.
20 Papa, Edith Stein I.
21 Pascual, Patricia Leane C.
22 Pineda, Noelie Bea L.
23 Rama, Lovely Joy L.
24 Reyes, Sheena Mae G.
25 Sangalang, Sheena O.
26 Santos, Samantha Claudine L.
27 Sarmiento, Alexis B.
28 Sarmiento, Roselyn M.
29 Simon, Rupert Joy E.
30 Sulapas, Melanie T.
31 Tarin, Riza
32 Velasquez, Regine S.
33 Vicente, Janelle M.

*Consent given Administered by: Noted by:

____________________
______________________ ____________ _____ ____________
Class Adviser Date Grade Level Teacher Date
Form 1 - Classroom Level Annex A1
School-based Weekly Iron Folic Acid (WIFA) Supplementation

Region: ______________ III Division: ______ CITY OF SAN JOSE DEL MONTE Date: ________________________________ School Year: ____ 2017-2018
School IC: _______________ Name of School: _____ SAPANG PALAY NATIONAL HIGH SCHOOL
Grade Level/Section: 8-PARAGUA No. of Students Enrolled: ___ 34 No. of Female Learners: 16 Address: _______ FATIMA V AREA E

Provided with Irno Folic Acid Supplements

Consent* 1st Round 2nd Round
LRN NAME OF LEARNER July August September January February March Remarks

Y N W1 W2 W3 W4 W1 W2 W3 W4 W1 W2 W3 W4 W1 W2 W3 W4 W1 W2 W3 W4 W1 W2 W3 W4
(date) (date) (date) (date) (date) (date) (date) (date) (date) (date) (date) (date) (date) (date) (date) (date) (date) (date) (date) (date) (date) (date) (date) (date)
1 Alanzalon, Heart Amaba
2 Autus , Ashley Jane Molo
3 Bruma , Kyla -
4 Chavaria , Anna Rose Kalivo
5 Dalida , Colline Lapena
6 De Vera , Justine Capunong
7 De Villa , Leonice Lacsao
8 Discartin , Christine Mae Navarra
9 Garcia, Jenn Maxine M.
10 Jose , Tricia Lyn Ronio
11 Malla , Lyka Jane Broqueza
12 Punzalan , Claudhete Kate -
13 Romero , Pinky Mae Deluyas
14 Sadinas , Angelica Mendoza
15 Villamor , Oli Mhea Domasig
16 Villasor , Cristina Casas

*Consent given Administered by: Noted by:

____________________
______________________ ____________ _____ ____________
Class Adviser Date Grade Level Teacher Date
Form 1 - Classroom Level Annex A1
School-based Weekly Iron Folic Acid (WIFA) Supplementation

Region: ______________ III Division: ______ CITY OF SAN JOSE DEL MONTE Date: ________________________________ School Year: ____ 2017-2018
School IC: _______________ Name of School: _____ SAPANG PALAY NATIONAL HIGH SCHOOL
Grade Level/Section: 8-SALVADOR No. of Students Enrolled: ___ 32 No. of Female Learners: 15 Address: _______ FATIMA V AREA E

Provided with Irno Folic Acid Supplements

Consent* 1st Round 2nd Round
LRN NAME OF LEARNER July August September January February March Remarks

Y N W1 W2 W3 W4 W1 W2 W3 W4 W1 W2 W3 W4 W1 W2 W3 W4 W1 W2 W3 W4 W1 W2 W3 W4
(date) (date) (date) (date) (date) (date) (date) (date) (date) (date) (date) (date) (date) (date) (date) (date) (date) (date) (date) (date) (date) (date) (date) (date)
1 Aninag , Anne Pauline Eneran
2 Arpociple , Cristine Joy Villaganes
3 Austria , Beatris Mae Mabana
4 Bansil , Yna Adel Guan
5 Bergonio , Jessica Artana
6 Borja , Julia Marie Madarang
7 Carbonel , Alexa Nicole Santos
8 Casil , Aira Mae Madura
9 Domondon , Kyla Mae Espellogo
10 Ferrater , Jevanny Ghiem Catubig
11 Flores , Kyla Mateo
12 Frilles , Rechelle Fucal
13 Impelido , Kathlyn Bartolome
14 Quijano , Anjalie Mae Borabo
15 Ramirez , Arian Jade Igros

*Consent given Administered by: Noted by:

____________________
______________________ ____________ _____ ____________
Class Adviser Date Grade Level Teacher Date
Form 1 - Classroom Level Annex A1
School-based Weekly Iron Folic Acid (WIFA) Supplementation

Region: ______________ III Division: ______ CITY OF SAN JOSE DEL MONTE Date: ________________________________ School Year: ____ 2017-2018
School IC: _______________ Name of School: _____ SAPANG PALAY NATIONAL HIGH SCHOOL
Grade Level/Section: 8-CARDOSO No. of Students Enrolled: ___ 31 No. of Female Learners: 16 Address: _______ FATIMA V AREA E

Provided with Irno Folic Acid Supplements

Consent* 1st Round 2nd Round
LRN NAME OF LEARNER July August September January February March Remarks

Y N W1 W2 W3 W4 W1 W2 W3 W4 W1 W2 W3 W4 W1 W2 W3 W4 W1 W2 W3 W4 W1 W2 W3 W4
(date) (date) (date) (date) (date) (date) (date) (date) (date) (date) (date) (date) (date) (date) (date) (date) (date) (date) (date) (date) (date) (date) (date) (date)
1 Andrada , Hyacinth Cariño
2 Baldecosta , Joy Marie Dalisay
3 Cabugayan , Adelyn Lusancio
4 Cruz , Mariel Lagarde
5 Damayo , Lovely May Yacat
6 De Juan , Gracely Mesada
7 De Mesa , Claudette Jizmundo
8 Esternon , Rocell Joy Sultado
9 Evangelio, Trisha Nicole G.
10 Jimenez , Anna Lennea Perido
11 Matillano , Jenny Rose Lañuza
12 Morales , Jennymel Gonzales
13 Muñoz , Jan Vallerie Ellen
14 Sambo , Abigail Sudario
15 Villanueva , Khrisna Gwyneth -
16 Viray , Thea Lourine Aventurado

*Consent given Administered by: Noted by:

____________________
______________________ ____________ _____ ____________
Class Adviser Date Grade Level Teacher Date
Form 1 - Classroom Level Annex A1
School-based Weekly Iron Folic Acid (WIFA) Supplementation

Region: ______________ III Division: ______ CITY OF SAN JOSE DEL MONTE Date: ________________________________ School Year: ____ 2017-2018
School IC: _______________ Name of School: _____ SAPANG PALAY NATIONAL HIGH SCHOOL
Grade Level/Section: 8-ARISTOTLE No. of Students Enrolled: ___ 31 No. of Female Learners: 17 Address: _______ FATIMA V AREA E

Provided with Irno Folic Acid Supplements

Consent* 1st Round 2nd Round
LRN NAME OF LEARNER July August September January February March Remarks

Y N W1 W2 W3 W4 W1 W2 W3 W4 W1 W2 W3 W4 W1 W2 W3 W4 W1 W2 W3 W4 W1 W2 W3 W4
(date) (date) (date) (date) (date) (date) (date) (date) (date) (date) (date) (date) (date) (date) (date) (date) (date) (date) (date) (date) (date) (date) (date) (date)
1 ALBES , SHIENA VILLAR
2 APOSTOL , XIANELL QUIAZ
3 BIAG , PHOEBIE LETRODO
4 CALNEA , ANDREA MAE CLARITO
5 CRUZ , KRIZLYN SILVESTRE
6 DAYAG , NEILLE MARIE VERITAS FABRO

7 DELA CRUZ , DNIEZE ZCHESLY ANN MARITO

8 DOCTOLERO , LYKA SHYDIE CAYETANO

9 LACERNA , LEIGHANNE ANGELA SUMARAGO

10 LAURIO , LARAHJEN DAÑUCOP

11 LIPATA , LALAINE CHARISMA ESTIGOY
12 PERADILLA , ALYSSA MAE DELA CRUZ
13 SABADERA , ALMIRA FAYE DELGADO
14 SANTOS , LOUIE ANDRE ELFA

15 SINOHIN , MCXYNNE COULETTE FRANCISCO

16 TORRES , FRANCHESKA YSABEL SOLANO

17 YAP , VIANCA SOPHIA GAL

*Consent given Administered by: Noted by:

____________________
______________________ ____________ _____ ____________
Class Adviser Date Grade Level Teacher Date
Form 1 - Classroom Level Annex A1
School-based Weekly Iron Folic Acid (WIFA) Supplementation
Region: III Division: City of San Jose del Monte Date: School Year: 2019-2020
School ID: _307511______________ Name of School: MARANGAL NATIONAL HIGH SCHOOL
Grade Level/Section: 10-Laurel No. of Students Enrolled: 60 No. of Female Learners: 30 Address: Towerville P6B, Bgy. Gaya-gaya, City of San Jose del Monte, Bulacan

Provided with Irno Folic Acid Supplements

Consent* 1st Round 2nd Round
LRN NAME OF LEARNER July August September January February March Remarks

Y N W1 W2 W3 W4 W1 W2 W3 W4 W1 W2 W3 W4 W1 W2 W3 W4 W1 W2 W3 W4 W1 W2 W3 W4
(date) (date) (date) (date) (date) (date) (date) (date) (date) (date) (date) (date) (date) (date) (date) (date) (date) (date) (date) (date) (date) (date) (date) (date)

*Consent given Administered by: Noted by:

____________________
______________________ ____________ _____ ____________
Class Adviser Date Grade Level Teacher Date