SBFP Form 1

Department of Education
Region III

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

Division/Province: Nueva Ecija Name of Principal : Annaliza G. Monce,Ph.D.

City/ Municipality/Barangay : Aliaga/Poblacion Centro Name of Feeding Focal Person : May B. Nieves
Name of School / School District : Aliaga Central School/Aliaga District

Date of Age in BMI for 6 Participation Beneficiary of SBFP

No. Name Sex Grade Date of Birth Weighing /
Years /
Weight Height
y.o. and
Nutritional Status in 4P's (Yes or Name of Parents in Previous Years
(MM/DD/YYYY) Measuring
Months
(Kg) (cm)
above (NS) No) (yes or no)
(MM/DD/YYYY)

Prepared by: Noted :

MAY B. NIEVES ANNALIZA G. MONCE,Ph.D.

Feeding Focal Person School Principal

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 2
Department of Education
Region III

SCHOOL-BASED FEEDING PROGRAM

Division/Province: Nueva Ecija
City/ Municipality/Barangay : Aliaga/ Poblacion Centro
Name of School / School District : Aliaga Central School/ Aliaga
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

Prepared by: Noted by:

MAY B. NIEVES ANNALIZA G. MONCE,Ph.D.

SBFP DepEd Focal Unit Chief

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 III

SCHOOL-BASED FEEDING PROGRAM

Division/Province: Nueva Ecija District: Aliaga District

School : Aliaga Central School Municipality: Aliaga

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:

MAY B. NIEVES ANNALIZA G. MONCE,Ph.D.

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

August 5, 2019 - January 24, 2020

III
Region ____________________________
Nueva Ecija
Division ___________________________ School: Aliaga Central School
Aliaga
District ___________________________

ACTUAL FEEDING
4Ps
PRE FEEDING
NAME OF PUPIL Beneficiary Beneficiary Nutritional Status Deworming
(y or n) of Previous Age Sex Ht Wt Date (√ ) or
Date
SBFP NS (X)
(y or n) Birth Date cm kg Taken Taken 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 ###
20
1 Bartolome, Maylene N N 6.0 05/18/13 F 1.04 12 06/06/19 SW / 7/4/2019 / / / / / / / / / / / / / / / / / / / /
2 Espinosa, Maria Blessie S. N N 6.3 02/16/13 F 1.15 15 06/06/19 SW / 7/4/2019 / / / / / / / / / / / / / / / / / / / /
3 Grajo, Ron Jay C. N N 6.1 04/23/13 M 1.05 14 06/04/19 SW / 7/4/2019 / / / / / / / / / / / / / / / / / / / /
4 Moreno, Catherine A. Y N 6.0 05/19/13 F 1.17 15 06/06/19 SW / 7/4/2019 / / / / / / / / / / / / / / / / / / / /
5 Nacino, Prince Airone F. Y N 7.6 12/01/11 M 1.30 18 06/04/19 SW / 7/4/2019 / / / / / / / / / / / / / / / / / / / /
6 Tolentino, Eury J. N N 8.2 03/12/11 M 1.16 16 06/04/19 SW / 7/4/2019 / / / / / / / / / / / / / / / / / / / /
7 Agustin, Jan Jade S. N N 7.6 11/10/11 M 1.25 18 06/04/19 SW / 7/4/2019 / / / / / / / / / / / / / / / / / / / /
8 Padilla, Angelika B. Y Y 7.4 01/10/12 F 1.27 19 06/06/19 SW / 7/4/2019 / / / / / / / / / / / / / / / / / / / /
9 Botones, Renz Nathan F. N N 9.5 12/16/09 M 1.26 18 06/04/19 SW / 7/4/2019 / / / / / / / / / / / / / / / / / / / /
10 Grajo, Christine C. N N 9.3 02/20/10 F 1.20 16 06/04/19 SW / 7/4/2019 / / / / / / / / / / / / / / / / / / / /
11 Ortiz, Mharison DC. N N 8.5 12/19/10 F 1.20 16 06/04/19 SW / 7/4/2019 / / / / / / / / / / / / / / / / / / / /
12 Sibal, Marry L. N N 8.2 03/21/11 F 1.16 15 06/04/19 W / 7/4/2019 / / / / / / / / / / / / / / / / / / / /
13 Bulawit, Andrea S. Y N 6.2 04/02/13 F 1.05 14 06/06/19 W / 7/4/2019 / / / / / / / / / / / / / / / / / / / /
14 Corpus, Hanna Claire S. N N 6.1 04/20/13 F 1.05 14 06/06/19 W / 7/4/2019 / / / / / / / / / / / / / / / / / / / /
15 Labrador, Pamela S. N N 6.0 05/20/13 F 1.09 15 06/06/19 W / 7/4/2019 / / / / / / / / / / / / / / / / / / / /
16 Claro, Ayesha Joy M. N N 6.3 03/05/13 F 1.10 15 06/06/19 W / 7/4/2019 / / / / / / / / / / / / / / / / / / / /
17 Dionisio, Princess Lyn N N 5.10 07/09/13 F 1.01 14 06/04/19 W / 7/4/2019 / / / / / / / / / / / / / / / / / / / /
18 Alfaro, James Rafael M. N N 7.7 10/14/14 M 1.24 20 06/04/19 W / 7/4/2019 / / / / / / / / / / / / / / / / / / / /
19 Lumberto, Kienzo P N Y 7.4 01/25/10 M 1.27 16 06/03/19 W / 7/4/2019 / / / / / / / / / / / / / / / / / / / /
20 Marcos, Joshua L. N N 7.1 04/10/12 M 1.11 16 06/03/19 W / 7/4/2019 / / / / / / / / / / / / / / / / / / / /
21 Pallado, Prince Amerson I. N Y 7.2 03/20/12 M 1.21 19 06/04/19 W / 7/4/2019 / / / / / / / / / / / / / / / / / / / /
22 San Mateo, Charmie Rain A. Y N 7.8 09/28/11 F 1.10 16 06/04/19 W / 7/4/2019 / / / / / / / / / / / / / / / / / / / /
23 Costales, Ma. Ellaine E. Y Y 7.7 10/15/2011 F 1.14 16 4/6/2019 W / 7/4/2019 / / / / / / / / / / / / / / / / / / / /
24 Magpayo, Ayesha H. N N 7.8 9/21/2011 F 1.15 16 4/6/2019 W / 7/4/2019 / / / / / / / / / / / / / / / / / / / /
25 Samson, Ayesha Mae S. Y Y 7.9 8/29/2011 F 1.15 16 4/6/2019 W / 7/4/2019 / / / / / / / / / / / / / / / / / / / /

Prepared by:
LEGEND
MAY B. NIEVES
____________________________ 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
 ACTUAL FEEDING
4Ps
PRE FEEDING
NAME OF PUPIL Beneficiary Beneficiary Nutritional Status Deworming
(y or n) of Previous Age Sex Ht Wt Date (√ ) or
Date
SBFP NS (X)
(y or n) Birth Date cm kg Taken Taken 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20
26 Villamil, Caleb Isaac Y N 7.0 5/29/2012 M 1.14 16 6/6/2019 W / 7/4/2019 / / / / / / / / / / / / / / / / / / / /
27 Martinez, Eurieken S. Y Y 7.5 12/22/2011 M 1.10 16 4/6/2019 W / 7/4/2019 / / / / / / / / / / / / / / / / / / / /
28 Dela Cruz, Andrea B. Y N 8.5 12/28/2010 F 1.20 18 4/6/2019 W / 7/4/2019 / / / / / / / / / / / / / / / / / / / /
29 Gonzales, Rhuwie Reindell S. N N 8.1 4/26/2011 M 1.17 18 4/6/2019 W / 7/4/2019 / / / / / / / / / / / / / / / / / / / /
30 Lubao, Cris Allen Jade O. N N 8.3 2/24/2011 M 1.18 18 4/6/2019 W / 7/4/2019 / / / / / / / / / / / / / / / / / / / /
31 Samson, Shaine Y N 8.9 8/22/2010 F 1.23 19 4/6/2019 W / 7/4/2019 / / / / / / / / / / / / / / / / / / / /
32 Halili, George J. N N 8.1 4/23/2011 M 1.22 19 4/6/2019 W / 7/4/2019 / / / / / / / / / / / / / / / / / / / /
33 Corpus, Stephanie Divine M. N N 8.1 5/1/2011 F 1.20 18 4/6/2019 W / 7/4/2019 / / / / / / / / / / / / / / / / / / / /

TOTAL:
Prepared by:
LEGEND
____________________________
MAY B. NIEVES 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
 SBFP Form 4

SCHOOL-BASED FEEDING PROGRAM

August 5, 2019 - January 24, 2020

III
Region ____________________________
Nueva Ecija
Division ___________________________ School : Aliaga Central School
Aliaga
District ___________________________

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 Bartolome, Maylene / / / / / / / / / / / / / / / / / / / / / / / / / / / / / / / / / / / / / / / /
2 Espinosa, Maria Blessie S. / / / / / / / / / / / / / / / / / / / / / / / / / / / / / / / / / / / / / / / /
3 Grajo, Ron Jay C. / / / / / / / / / / / / / / / / / / / / / / / / / / / / / / / / / / / / / / / /
4 Moreno, Catherine A. / / / / / / / / / / / / / / / / / / / / / / / / / / / / / / / / / / / / / / / /
5 Nacino, Prince Airone F. / / / / / / / / / / / / / / / / / / / / / / / / / / / / / / / / / / / / / / / /
6 Tolentino, Eury J. / / / / / / / / / / / / / / / / / / / / / / / / / / / / / / / / / / / / / / / /
7 Agustin, Jan Jade S. / / / / / / / / / / / / / / / / / / / / / / / / / / / / / / / / / / / / / / / /
8 Padilla, Angelika B. / / / / / / / / / / / / / / / / / / / / / / / / / / / / / / / / / / / / / / / /
9 Botones, Renz Nathan F. / / / / / / / / / / / / / / / / / / / / / / / / / / / / / / / / / / / / / / / /
10 Grajo, Christine C. / / / / / / / / / / / / / / / / / / / / / / / / / / / / / / / / / / / / / / / /
11 Ortiz, Mharison DC. / / / / / / / / / / / / / / / / / / / / / / / / / / / / / / / / / / / / / / / /
12 Sibal, Marry L. / / / / / / / / / / / / / / / / / / / / / / / / / / / / / / / / / / / / / / / /
13 Bulawit, Andrea S. / / / / / / / / / / / / / / / / / / / / / / / / / / / / / / / / / / / / / / / /
14 Corpus, Hanna Claire S. / / / / / / / / / / / / / / / / / / / / / / / / / / / / / / / / / / / / / / / /
15 Labrador, Pamela S. / / / / / / / / / / / / / / / / / / / / / / / / / / / / / / / / / / / / / / / /
16 Claro, Ayesha Joy M. / / / / / / / / / / / / / / / / / / / / / / / / / / / / / / / / / / / / / / / /
17 Dionisio, Princess Lyn / / / / / / / / / / / / / / / / / / / / / / / / / / / / / / / / / / / / / / / /
18 Alfaro, James Rafael M. / / / / / / / / / / / / / / / / / / / / / / / / / / / / / / / / / / / / / / / /
19 Lumberto, Kienzo P / / / / / / / / / / / / / / / / / / / / / / / / / / / / / / / / / / / / / / / /
20 Marcos, Joshua L. / / / / / / / / / / / / / / / / / / / / / / / / / / / / / / / / / / / / / / / /
21 Pallado, Prince Amerson I. / / / / / / / / / / / / / / / / / / / / / / / / / / / / / / / / / / / / / / / /
22 San Mateo, Charmie Rain A. / / / / / / / / / / / / / / / / / / / / / / / / / / / / / / / / / / / / / / / /
23 Costales, Ma. Ellaine E. / / / / / / / / / / / / / / / / / / / / / / / / / / / / / / / / / / / / / / / /
24 Magpayo, Ayesha H. / / / / / / / / / / / / / / / / / / / / / / / / / / / / / / / / / / / / / / / /
25 Samson, Ayesha Mae S. / / / / / / / / / / / / / / / / / / / / / / / / / / / / / / / / / / / / / / / /
TOTAL:

Prepared by:
LEGEND
D. Actual Feeding
A. Nutritional Status
B. Deworming D. Actual Feeding
MAY B. NIEVES ( √ ) - Present, served For 6-19 y.o For below 6 y.o
School Feeding Teacher ( A ) - Absent, not served SW - Severely wasted
SU - Severely underweight
( x ) - not dewormed ( √ ) - Present, served
(√√ ) - Present, served twice W - Wasted U - Underweight ( √ ) - dewormed ( A ) - Absent, not served
N - Normal N - Normal (√√ ) - Present, served twice
Ow - Overwieght Ow - Overwieght
O - Obese

ACTUAL FEEDING

NAME OF PUPIL
page 2
 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
26 Villamil, Caleb Isaac / / / / / / / / / / / / / / / / / / / / / / / / / / / / / / / / / / / / / / / /
27 Martinez, Eurieken S. / / / / / / / / / / / / / / / / / / / / / / / / / / / / / / / / / / / / / / / /
28 Dela Cruz, Andrea B. / / / / / / / / / / / / / / / / / / / / / / / / / / / / / / / / / / / / / / / /
29 Gonzales, Rhuwie Reindell S. / / / / / / / / / / / / / / / / / / / / / / / / / / / / / / / / / / / / / / / /
30 Lubao, Cris Allen Jade O. / / / / / / / / / / / / / / / / / / / / / / / / / / / / / / / / / / / / / / / /
31 Samson, Shaine / / / / / / / / / / / / / / / / / / / / / / / / / / / / / / / / / / / / / / / /
32 Halili, George J. / / / / / / / / / / / / / / / / / / / / / / / / / / / / / / / / / / / / / / / /
33 Corpus, Stephanie Divine M. / / / / / / / / / / / / / / / / / / / / / / / / / / / / / / / / / / / / / / / /

TOTAL:

Prepared by:
LEGEND
D. Actual Feeding
MAY B. NIEVES A. Nutritional Status
B. Deworming D. Actual Feeding
School Feeding Teacher ( √ ) - Present, served For 6-19 y.o For below 6 y.o
( A ) - Absent, not served SW - Severely wasted
SU - Severely underweight
( x ) - not dewormed ( √ ) - Present, served
(√√ ) - Present, served twice W - Wasted U - Underweight ( √ ) - dewormed ( A ) - Absent, not served
N - Normal N - Normal (√√ ) - Present, served twice
Ow - Overwieght Ow - Overwieght
O - Obese

page 2
 SBFP Form 4

SCHOOL-BASED FEEDING PROGRAM

August 5, 2019 - January 24, 2020

III
Region ____________________________
Nueva Ecija
Division ___________________________ Aliaga Central School
Aliaga
District ___________________________

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 Bartolome, Maylene / / / / / / / / / / / / / / / / / / / / / / / / / / / / / / / / / / / / / / / /
2 Espinosa, Maria Blessie S. / / / / / / / / / / / / / / / / / / / / / / / / / / / / / / / / / / / / / / / /
3 Grajo, Ron Jay C. / / / / / / / / / / / / / / / / / / / / / / / / / / / / / / / / / / / / / / / /
4 Moreno, Catherine A. / / / / / / / / / / / / / / / / / / / / / / / / / / / / / / / / / / / / / / / /
5 Nacino, Prince Airone F. / / / / / / / / / / / / / / / / / / / / / / / / / / / / / / / / / / / / / / / /
6 Tolentino, Eury J. / / / / / / / / / / / / / / / / / / / / / / / / / / / / / / / / / / / / / / / /
7 Agustin, Jan Jade S. / / / / / / / / / / / / / / / / / / / / / / / / / / / / / / / / / / / / / / / /
8 Padilla, Angelika B. / / / / / / / / / / / / / / / / / / / / / / / / / / / / / / / / / / / / / / / /
9 Botones, Renz Nathan F. / / / / / / / / / / / / / / / / / / / / / / / / / / / / / / / / / / / / / / / /
10 Grajo, Christine C. / / / / / / / / / / / / / / / / / / / / / / / / / / / / / / / / / / / / / / / /
11 Ortiz, Mharison DC. / / / / / / / / / / / / / / / / / / / / / / / / / / / / / / / / / / / / / / / /
12 Sibal, Marry L. / / / / / / / / / / / / / / / / / / / / / / / / / / / / / / / / / / / / / / / /
13 Bulawit, Andrea S. / / / / / / / / / / / / / / / / / / / / / / / / / / / / / / / / / / / / / / / /
14 Corpus, Hanna Claire S. / / / / / / / / / / / / / / / / / / / / / / / / / / / / / / / / / / / / / / / /
15 Labrador, Pamela S. / / / / / / / / / / / / / / / / / / / / / / / / / / / / / / / / / / / / / / / /
16 Claro, Ayesha Joy M. / / / / / / / / / / / / / / / / / / / / / / / / / / / / / / / / / / / / / / / /
17 Dionisio, Princess Lyn / / / / / / / / / / / / / / / / / / / / / / / / / / / / / / / / / / / / / / / /
18 Alfaro, James Rafael M. / / / / / / / / / / / / / / / / / / / / / / / / / / / / / / / / / / / / / / / /
19 Lumberto, Kienzo P / / / / / / / / / / / / / / / / / / / / / / / / / / / / / / / / / / / / / / / /
20 Marcos, Joshua L. / / / / / / / / / / / / / / / / / / / / / / / / / / / / / / / / / / / / / / / /
21 Pallado, Prince Amerson I. / / / / / / / / / / / / / / / / / / / / / / / / / / / / / / / / / / / / / / / /
22 San Mateo, Charmie Rain A. / / / / / / / / / / / / / / / / / / / / / / / / / / / / / / / / / / / / / / / /
23 Costales, Ma. Ellaine E. / / / / / / / / / / / / / / / / / / / / / / / / / / / / / / / / / / / / / / / /
24 Magpayo, Ayesha H. / / / / / / / / / / / / / / / / / / / / / / / / / / / / / / / / / / / / / / / /
25 Samson, Ayesha Mae S. / / / / / / / / / / / / / / / / / / / / / / / / / / / / / / / / / / / / / / / /
TOTAL:

Prepared by:
LEGEND
D. Actual Feeding
MAY B. NIEVES A. Nutritional Status
B. Deworming D. Actual Feeding
School Feeding Teacher ( √ ) - Present, served For 6-19 y.o For below 6 y.o
( A ) - Absent, not served SW - Severely wasted
SU - Severely underweight
( x ) - not dewormed ( √ ) - Present, served
(√√ ) - Present, served twice W - Wasted U - Underweight ( √ ) - dewormed ( A ) - Absent, not served
N - Normal N - Normal (√√ ) - Present, served twice
Ow - Overwieght Ow - Overwieght
O - Obese

page 3
 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
26 Villamil, Caleb Isaac / / / / / / / / / / / / / / / / / / / / / / / / / / / / / / / / / / / / / / / /
27 Martinez, Eurieken S. / / / / / / / / / / / / / / / / / / / / / / / / / / / / / / / / / / / / / / / /
28 Dela Cruz, Andrea B. / / / / / / / / / / / / / / / / / / / / / / / / / / / / / / / / / / / / / / / /
29 Gonzales, Rhuwie Reindell S. / / / / / / / / / / / / / / / / / / / / / / / / / / / / / / / / / / / / / / / /
30 Lubao, Cris Allen Jade O. / / / / / / / / / / / / / / / / / / / / / / / / / / / / / / / / / / / / / / / /
31 Samson, Shaine / / / / / / / / / / / / / / / / / / / / / / / / / / / / / / / / / / / / / / / /
32 Halili, George J. / / / / / / / / / / / / / / / / / / / / / / / / / / / / / / / / / / / / / / / /
33 Corpus, Stephanie Divine M. / / / / / / / / / / / / / / / / / / / / / / / / / / / / / / / / / / / / / / / /

TOTAL:

Prepared by: LEGEND

D. Actual Feeding
A. Nutritional Status
B. Deworming D. Actual Feeding
MAY B. NIEVES ( √ ) - Present, served For 6-19 y.o For below 6 y.o
School Feeding Teacher ( A ) - Absent, not served SW - Severely wasted
SU - Severely underweight
( x ) - not dewormed ( √ ) - Present, served
(√√ ) - Present, served twice W - Wasted U - Underweight ( √ ) - dewormed ( A ) - Absent, not served
N - Normal N - Normal (√√ ) - Present, served twice
Ow - Overwieght Ow - Overwieght
O - Obese

page 3
 SBFP Form 4

SCHOOL-BASED FEEDING PROGRAM

October 26, 2020 - February , 2020

III
Region ____________________________
Nueva Ecija
Division ___________________________ School: _____Betes Elementary School__________________
Aliaga
District ___________________________

ACTUAL FEEDING POST FEEDING

ATTENDANCE
NAME OF PUPIL Nutritional Status Days Feeding
Percentage
Ht Wt Date Present Days

26 27 28 29 30 2 3 4 5 6 9 10 11 12 13 14 17 18 19 20 21 cm kg Taken NS (A) (B) (A/B)*100

1 / / / / / / / / / / / 100%
2 / / / / / / / / / / / 100%
3 / / / / / / / / / / / 100%
4 / / / / / / / / / / / 100%
5 / / / / / / / / / / / 100%
6 / / / / / / / / / / / 100%
7 / / / / / / / / / / / 100%
8 / / / / / / / / / / / 100%
9 / / / / / / / / / / / 100%
10 / / / / / / / / / / / 100%
11 / / / / / / / / / / / 100%
12 / / / / / / / / / / / 100%
13 / / / / / / / / / / / 100%
14 / / / / / / / / / / / 100%
15 / / / / / / / / / / / 100%
16 / / / / / / / / / / / 100%
17 / / / / / / / / / / / 100%
18 / / / / / / / / / / / 100%
19 / / / / / / / / / / / 100%
20 / / / / / / / / / / / 100%
21 / / / / / / / / / / / 100%
22 / / / / / / / / / / / 100%
23 / / / / / / / / / / / 100%
24 / / / / / / / / / / / 100%
25 / / / / / / / / / / / 100%
TOTAL: AVERAGE: 100%

Prepared by: LEGEND

A. Nutritional Status D. Actual Feeding
D. Actual Feeding B. Deworming
CIRLA P. LIMBAN For 6-19 y.o For below 6 y.o
School Feeding Teacher ( √ ) - Present, served SW - Severely wasted
SU - Severely underweight
( x ) - not dewormed ( √ ) - Present, served
( A ) - Absent, not served W - Wasted U - Underweight ( √ ) - dewormed ( A ) - Absent, not served
(√√ ) - Present, served twice N - Normal N - Normal (√√ ) - Present, served twice
Ow - Overwieght Ow - Overwieght
O - Obese

page 4
 SBFP Form 4
SCHOOL-BASED FEEDING PROGRAM
October 26, 2020 - February , 2020
Region ____________________________
III
Nueva Ecija
Division ___________________________ School: _____Betes Elementary School__________________
Aliaga
District ___________________________

ACTUAL FEEDING POST FEEDING ATTENDANCE

Nutritional Status Days Feeding
NAME OF PUPIL Percentage
Ht Wt Date Present Days
26 27 28 29 30 2 3 4 5 6 9 10 11 12 13 14 17 18 19 20 21 cm kg Taken NS (A) (B) (A/B)*100
1 / / / / / / / / / / / 100%
2 / / / / / / / / / / / 100%
3 / / / / / / / / / / / 100%
4 / / / / / / / / / / / 100%
5 / / / / / / / / / / / 100%
6 / / / / / / / / / / / 100%
7 / / / / / / / / / / / 100%
8 / / / / / / / / / / / 100%
9 / / / / / / / / / / / 100%
10 / / / / / / / / / / / 100%
11 / / / / / / / / / / / 100%
12 / / / / / / / / / / / 100%
13 / / / / / / / / / / / 100%
14 / / / / / / / / / / / 100%
15 / / / / / / / / / / / 100%
16 / / / / / / / / / / / 100%
17 / / / / / / / / / / / 100%
18 / / / / / / / / / / / 100%
19 / / / / / / / / / / / 100%
20 / / / / / / / / / / / 100%
21 / / / / / / / / / / / 100%
22 / / / / / / / / / / / 100%
23 / / / / / / / / / / / 100%
24 / / / / / / / / / / / 100%
25 / / / / / / / / / / / 100%
TOTAL: AVERAGE: 100%

Prepared by: LEGEND

A. Nutritional Status D. Actual Feeding
D. Actual Feeding B. Deworming
CIRLA P. LIMBAN For 6-19 y.o For below 6 y.o
School Feeding Teacher ( √ ) - Present, served SW - Severely wasted
SU - Severely underweight
( x ) - not dewormed ( √ ) - Present, served
( A ) - Absent, not served W - Wasted U - Underweight ( √ ) - dewormed ( A ) - Absent, not served
(√√ ) - Present, served twice N - Normal N - Normal (√√ ) - Present, served twice
Ow - Overwieght Ow - Overwieght
O - Obese

page 4
SBFP Form 5
SCHOOL-BASED FEEDING PROGRAM

CONSOLIDATED NUTRITIONAL STATUS AND ATTENDANCE REPORT

Region: III School Year 2019-2020
Division/District: Nueva Ecija
SchAliaga Central School
BEIS ID No. 105171
NUTRITIONAL STATUS
No. of Pupils PERCENTAGE
GRADES AND SECTIONS BEFORE ENDLINE
Dewormed ATTENDANCE
SW/SU W/U N Ow Ob Total SW/SU W/U N Ow O Total
1 Kinder 2 2 0 2 0 0 2 2 100%
2 Grade I 7 2 5 7 0 0 7 7 100%
3 Grade II 14 4 10 14 0 0 14 14 100%
4 Grade III 10 4 6 10 0 0 10 10 100%

12 21 33 0 0 33 33
TOTAL AVERAGE: 100%
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:
_____________________________
MAY B. NIEVES ANNALIZA G. MONCE,Ph.D.
___________________________
SBFP Focal Person School Principal II

Note: This form shall be prepared by the school using the data from SBFP Form 4.

No. of Pupils
GRADES AND SECTIONS BEFORE
Dewormed
SW/SU W/U N Ow
21 Esmas, Jay-M M. / /
22 Francisco, Airha B. / /
23 Guevarra, Ray angelo T. / /
24 Lina, Krizzia Marianne T. / /
25 Mendoza, Ninween Joaqui / /
26 Padila, Victor Mharr B. / /
27 Fronda, Aiva John H. / /
28 Garcia, Niño S. / /
29 Garson, Mark Rainier A. / /
30 Lorenzo, Marilou A. / /
31 Manialong, Mark Arvin R. / /
TOTAL 11
NUTRITIONAL STATUS
PERCENTAGE
AFTER
ATTENDANCE
Ob Total SW/SU W/U N Ow O Total
/ 100%
/ 100%
/ 100%
/ 100%
/ 100%
/ 100%
/ 100%
/ 100%
/ 100%
/ 100%
/ 100%
AVERAGE: