SCHOOL-BASED FEEDING PROGRAM

S.Y. 2020-2021
Region: III
Division: Nueva Ecija School: Faigal Elementary School
District: Guimba East

PRE FEEDING ACTUAL FEEDING

Beneficiary
4Ps Nutritional Status Deworming
of Previous 01/04/21 01/05/21 01/06/21 01/07/21 01/08/21 01/11/21
NAME OF PUPIL Beneficiary
SBFP (y or Age Birth Date Sex
(y or n) Wt Ht Date (√ ) or
n) NS Date Taken
m2 (X) DAY 1 DAY 2 DAY 3 DAY 4 DAY 5 DAY 6
kg
AYUSTE, YURI S.
1 n n 7 7/28/2013 M √ √ √ √ √ √
BARET, JHON GABRIEL C.
2 n n 6/12/2015 M √ √ √ √ √ √
5
BARIT, KEVIN Y.
3 n n 9/15/2014 MM √ √ √ √ √ √
6
BOTER, DARWN S.
4 n n 9/18/2014 M √ √ √ √ √ √
6
DACAYO, ROLLYCO JR, V.
5 n n 6 7/26/2014 √ √ √ √ √ √
M
GARDOCE, MAC ALDRIN B.
6 n n 5 4/23/2015 √ √ √ √ √ √
M
GRAGANZA, STEVEN RICK
7 n n 5 3/29/2015 √ √ √ √ √ √
M
MAGNO, NEL EBCIDIC P.
8 n n 6 10/27/2014 √ √ √ √ √ √
M
LAPITAN, KYLE ANDREW A.
9 n n 5 9/6/2015 √ √ √ √ √ √
M
RUBANG, BERNIE JR A.
10 n n 5 4/23/2015 √ √ √ √ √ √
M
RUBANG, JAYPIE L.
11 n n 5.00 10/25/2014 √ √ √ √ √ √
M
TOTAL 11 11 11 11 11 11

Prepared by:
LEGEND
MARJORIE Q. BARRERA 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

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