SBFP Form 1

Department of Education
Region XII

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

S.Y.2020-2021
Division/Province: South Cotabato Name of Principal : ________ Leo E. Jumantoc
City/ Municipality/Barangay : Tboli / New Dumangas Name of Feeding Focal Person : Janneth V.Pescuela
Name of School / School District : Tabudtod Elementary School / Tboli West District

Grade/ Date of Weighing / Age in Weight Height BMI for 6 Nutritional Participation in
Date of Birth
No. Name Sex Measuring Years / y.o. and 4Ps Name of Parents Signature
Section (MM/DD/YYYY)
(MM/DD/YYYY) Months (Kg) (cm)
above Status (NS)
(yes or no)
1 Adio, Jozel Colan M Kinder-One 9/4/2014 no Adio, Robert S.
2 Ballaran, Francis Adio M Kinder-One 1/13/2015 no Adio, Madilyn S.
3 Caballelro, Johnreal Espestan M Kinder-One 5/14/2015 yes Caballero, Renato T.
4 Camacho, Kent Lorenz Bargasa M Kinder-One 3/22/2015 no Camacho, Jayson M.
5 Garmay, Ghebe Cristobal M Kinder-One 3/29/2015 no Garmay, Gerald G.
6 Gegantoni, Von Andrei Braceros M Kinder-One 8/11/2015 no Gegantoni, Jushiel B.
7 Hemoros, Zhian Cris Perez M Kinder-One 4/5/2015 no Hemoros, Vilmar M.
8 Palma, Zayne Hairo Legarde M Kinder-One 5/4/2015 no Palma, Roldan G.
9 Salig, Jared Ruzzel Espestan M Kinder-One 4/13/2015 no Salig, Jaredque B.
10 Serue, Gabriel Asistido M Kinder-One 3/11/2015 no Serue, Jeoberth G.
11 Sumodio, John Gabriel Silva M Kinder-One 7/29/2015 no Sumodio, Antonio L.
12 Alas, Klea Charisse Adio F Kinder-One 2/16/2015 yes Alas, Ernesto O.
13 Bayona, Janine Kaye Palma F Kinder-One 12/17/2014 no Bayona, Renboy T.
14 Capilitan, Kathlyn Genanda F Kinder-One 10/17/2014 no Capilitan, Melchor T.
15 Distor, Abbygyle Meniel F Kinder-One 11/11/2014 no Distor, Bobby P.
16 Girado, Kyle Veniece Meniel F Kinder-One 6/2/2015 yes Girado, Adonis E.
17 Padilla, Krystyl Hope Suropia F Kinder-One 9/21/2015 no Padilla, Ricky G.
18 Pamplona, Cyan Rhumzel Cia F Kinder-One 3/20/2015 no Pamplona, Jomer Jan V.
19 Pescuela, Azaiah Love Vinculado F Kinder-One 9/17/2014 no Pescuela, Joeffrey F.
20 Serue, Andrey Pearl Maladia F Kinder-One 12/20/2014 no Serue, Jarold Jan M.
21 Velasco, Andrea Adio F Kinder-One 11/8/2014 no Velasco, Sarrah Mae A.
22 Gayapa, John Francis Girado M One-One 4/9/2014 yes Gayapa, Jonerey T.
23 Tulayan, Fretz Rubiano M One-One 11/25/2013 no Tulayan, Rechie C..
24 Velasco, Prince Chelson M One-One 6/19/2014 no Velasco, Retchel F.
25 Zambrano, Kristoff Neo Ferrer M One-One 1/1/2014 no Zambrano, Kristopher C.
26 Braceros, Kathleen Tusalem F One-One 8/21/2014 no Braceros, Carlo G.
27 Cristobal, Althea Gawal F One-One 8/24/2014 no Cristobal, Anthony A.
28 Entero, Katelyn Miles Gawal F One-One 11/16/2013 no Entero, Jeffrey
29 Lamigo, Emy Rose Billones F One-One 8/9/2014 no Lamigo, Erwin
30 Perez, Jail Maree F One-One 11/18/2012 yes Perez, Harry Gil S.
31 Blasé, April Jay Gawal M One-One 11/20/2013 no Blasé, Anabella G.
32 Gurango, Jhon Rex Espolong M One-One 1/11/2014 no Gurango, Aiza E.
33 Alas, Kyle Zyrus A. M One-One 1/6/2014 yes Alas, Richelle A.
34 Pianar, Aljhon A. M One-One 5/23/2014 yes Piañar, Annabelle A.
35 Almeria, Javy Ian P. M Two-One 11/4/2011 no Almeria, Leonido D.
36 Almeria, Alvincer P. M Two-One 1/7/2013 no Almeria, Leonido D.
37 Manake, Argie E. M Two-One 7/18/2013 no Manake, Tomi L.
38 Ligad, Earl Angelo P. M Two-One 9/23/2012 no Ligad, Emy P.
39 Garcesto, Alexa F Two-One 12/9/2012 no Garcesto, Margie S,
40 Catil, Claire Adio F Two-One 4/3/2011 yes Catil, Suzane A.
41 Meniel, Cyra Venice L. F Two-One 9/23/2012 no Meniel, Geybert G.
42 Adio, Jhanna Marie C. F Two-One 1/18/2013 no Adio, Margie C.
43 Beceslao,Krizelle Mitch G. F Two-One 9/28/2012 no Beceslao, Jenelyn G.
44 Garmay, Fiona D. F Two-One 8/1/2013 no Garmay, April Rose D.
45 Serue, Raphael Dave S. M Two-One 8/31/2012 no Serue, Joeberth G.
46 Almeria,Prince Lorenz P. M Two-One 1/19/2013 no Almeria, Ernilo
47 Alas, Renz A. M Three-One 3/31/2012 yes Alas, Richelle A.
48 Catil, Jonie A. M Three-One 3/31/2011 yes Catil, Suzane A.
49 Salig, Kien John E. M Three-One 4/9/2011 no Salig, Jaredque B.
50 Carpe, Jorilou F. F Three-One 8/30/2011 no Carpe, Mitchie F.
51 Perater, Arcelea C. F Three-One 12/1/2011 yes Perater, Arsenio N.
52 Cristobal,Kiara May G. F Three-One 5/24/2012 no Cristobal, Anthony A.
53 Garceto, Krizelle S. F Three-One 6/11/2012 yes Garceto, Nancy S.
54 Manake, Julie Mae E. F Three-One 7/12/2011 no Manake, Tomi L.
55 Pianar, Jharriena A. F Three-One 4/14/2013 yes Piañar, Annabelle A.
56 Braceros, Revo S. M Four- One 3/26/2011 yes Braceros, Vivian S.
57 Girado, John Albert T. M Four- One 12/1/2010 yes Girado, Adrian E.
58 Ferrer, Jayson T. M Four- One 9/1/2011 no Ferrer, Jaypee G.
59 Catil, Katrina A.. F Four- One 3/25/2010 yes Catil, Suzane A.
60 Gestosani, Catherine G. F Four- One 6/23/2011 no Gestosani, Louise Bryan P.
61 Caballero. Rey John E. M Five-One 7/22/2010 yes Caballero,Renato T.
62 Genanda, Cesar M Five-One 1/12/2010 no Genanda, Nemesio N.
63 Gensola, Duane Andrew P. M Five-One 1/8/2010 no Perez, Genevieve S.
64 Alas, Shyrine Joy A. F Five-One 9/2/2010 yes Alas, Richelle A.
65 Garceto, Killy Jane S. F Five-One 7/24/2010 yes Garceto, Nancy S.
66 Gawal, Aya Vion Ky P. F Five-One 8/19/2010 no Gawal, Arnold G.
67 Meniel, Stephanie Nicole F Five-One 9/10/2010 no Meniel, Robert G.,Jr.
68 Perez, Jean Clarize S. F Five-One 3/30/2010 yes Perez, Harry Gil S.
69 Tulayan, Merry Joy R. F Five-One 1/25/2010 no Tulayan, Rechie C..
70 Salig, Chariah Mae E. F Five-One 12/1/2009 no Salig, Jaredque B.
71 Garmay, Zymoon M Six-One 5/9/2009 no Garmay, Edgar
72 Billones, Rodzel S. M Six-One 11/23/2008 no Billones, Edgar
73 Velasco, Serwin A. M Six-One 6/8/2009 yes Velasco, Merlinda A.
 74 Blasé, Ivy G. F Six-One 2/26/2009 no Blasé, Anabella G.
75 Talde. Aira Clarisse F Six-One 2/27/2009 yes Talde, Maribeth
76 Perater, Arce C. M Six-One 2/23/2009 yes Perater, Arsenio N.
77 Ballaran, Trisha A. F Two-One 12/12/2012 no Ballaran, Madilyn A.
78 Erio, Zhunn Jycraig M Two-One 11/17/2013 no Erio, Sylvia
79 Sumodio, Charmaine S. F Three-One 7/17/2012 no Sumodio, Antonio L.
80 Sumilhig, Benedict L. M Two-One 2/14/2013 no Sumilhig, Dante

Prepared by:

____ Janneth V. Pescuela

Feeding Focal Person

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 DepEd-HNC
SBFP Form 2
Department of Education
Region XII

SCHOOL-BASED FEEDING PROGRAM (SBFP) LIST OF SCHOOLS

Division/Province: South Cotabato

School District/City/ Municipality : Tboli West II District/Tboli

Name of District Supervisors/ Total

Name of Schools BEIS ID No. School Address Name of Barangay Contact Number
School Principal or OICs Beneficiaries
Tabudtod Elementary School 130843 Tabudtod,New Dumangas,Tboli New Dumangas Crisanto M. Bulado 80

Prepared by: Noted by:

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 3 (for 2020-2021 fund only)
Department of Education
Region __XII_

SCHOOL-BASED FEEDING PROGRAM (SBFP) SUMMARY OF BENEFICIARIES & START OF FEEDING

Division/Province: South Cotabato
City/ Municipality/Barangay : Tboli/ New Dumangas
Name of School / School District : Tabudtod Elementary School/ Tboli West

Date of Start of Feeding: __________________________

Nutritional Status at Start of Feeding

Number of Undernourished School
Children by Grade Level No. of No. of Pupils who
Severely No. of Total No. of 4 Ps are beneficiaries in
Wasted Wasted Normal Beneficiaries Beneficiaries previous years Remarks

1. Grade I 13 4 2

2. Grade II 15 2 6

3. Grade III 10 5 5

4. Grade IV 5 3 2

5. Grade V 10 4 5

6.. Grade VI 6 3 4

Kinder 21 3 0

Total 80 24 24

Prepared by:

JANNETH V. PESCUELA
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 DepEd-HNC
 SBFP Form 4
SCHOOL-BASED FEEDING PROGRAM
RECORD OF DAILY FEEDING

FOR THE MONTH OF ______________________ , SY _____________

Region ____________________________
Division ___________________________ School: _____________________________________
District ___________________________ Grade: __________ Section _____________________

ACTUAL FEEDING
PRE FEEDING
4Ps
NAME OF PUPIL Beneficiary Beneficiary Nutritional Status Deworming
(y or n) of Previous Ht Wt Date
SBFP
Age Birth Sex (√ ) or Date
NS
(y or n) 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
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
TOTAL:
Prepared by:
LEGEND
____________________________ 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

Page 6
Note: This form shall be prepared by the school to be consolidated using SBFP Form 5

Page 7
 SBFP Form 4

SCHOOL-BASED FEEDING PROGRAM

FOR THE MONTH OF ______________________ , SY _____________

Region ____________________________
Division ___________________________ School: _____________________________________
District ___________________________ Grade: __________ Section _____________________

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

D. Actual Feeding

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

page 2
 SBFP Form 4

SCHOOL-BASED FEEDING PROGRAM

FOR THE MONTH OF ______________________ , SY _____________

Region ____________________________
Division ___________________________ School: _____________________________________
District ___________________________ Grade: __________ Section _____________________

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

D. Actual Feeding

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

page 3
 SBFP Form 4

SCHOOL-BASED FEEDING PROGRAM

FOR THE MONTH OF ______________________ , SY _____________

Region ____________________________
Division ___________________________ School: _____________________________________
District ___________________________ Grade: __________ Section _____________________

ACTUAL FEEDING POST FEEDING

ATTENDANCE
NAME OF PUPIL Nutritional Status Days Feeding
Percentage
Ht Wt Date Present Days
### 102 ### ### ### ### ### ### ### ### ### 112 113 114 115 116 117 118 119 120 cm kg Taken NS (A) (B) (A/B)*100
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
TOTAL: AVERAGE:

D. Actual Feeding

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

page 4
page 4
SBFP Form 3
Department of Education
Region ___

SCHOOL-BASED FEEDING PROGRAM (SBFP) SUMMARY OF BENEFICIARIES & START OF FEEDING

Division/Province: ______________________________________
City/ Municipality/Barangay : ____________________________
Name of School / School District : _________________________

Date of Start of Feeding: __________________________

Nutritional Status at Start of Feeding

Number of Undernourished School
Children by Grade Level No. of No. of Pupils who
Severely No. of Total No. of 4 Ps are beneficiaries in
Wasted Wasted Beneficiaries Beneficiaries previous years Remarks

1. Kinder

2. Grade I

3. Grade II

4. Grade III

5. Grade IV

6. Grade V

7. Grade VI

Total

Prepared by:

______________________________________
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 DepEd-HNC
 SBFP Form 3
Department of Education
Region ___

SCHOOL-BASED FEEDING PROGRAM (SBFP) SUMMARY OF BENEFICIARIES & START OF FEEDING

Division/Province: ______________________________________
City/ Municipality/Barangay : ____________________________
Name of School / School District : _________________________

Date of Start of Feeding: __________________________

Kinder
Nutritional Status at Start of Feeding
Number of Undernourished
School Childrenby
district/School Level No. of Pupils who
No. of Severely No. of Total No. of 4 Ps are beneficiaries in
Wasted Wasted Beneficiaries Beneficiaries previous years Remarks

1 Banga East 63

2 Banga North 56

3 Banga South

4 Lake Sebu East

5 Lake Sebu West

6 Norala

7 Polomolok East

8 Polomolok West

9 Surallah Central

10 Surallah North

11 Surallah South

12 Sto. Niño

13 Tampakan

14 Tantangan

15 Tboli East

16 Tboli West

17 Tupi North

18 Tupi south

Total

Prepared by:

______________________________________
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 DepEd-HNC
 SBFP Form 3
Department of Education
Region ___

SCHOOL-BASED FEEDING PROGRAM (SBFP) SUMMARY OF BENEFICIARIES & START OF FEEDING

Division/Province: ______________________________________
City/ Municipality/Barangay : ____________________________
Name of School / School District : _________________________

Date of Start of Feeding: __________________________

Grade I
Nutritional Status at Start of Feeding
Number of Undernourished School
Childrenby district/School Level No. of No. of Pupils who
Severely No. of Total No. of 4 Ps are beneficiaries in
Wasted Wasted Beneficiaries Beneficiaries previous years Remarks

1 Banga East 20

2 Banga North

3 Banga South

4 Lake Sebu East

5 Lake Sebu West

6 Norala

7 Polomolok East

8 Polomolok West

9 Surallah Central

10 Surallah North

11 Surallah South

12 Sto. Niño
13 Tampakan

14 Tantangan

15 Tboli East

16 Tboli West

17 Tupi North

18 Tupi south

Total

Prepared by:

______________________________________
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 DepEd-HNC
 SBFP Form 3
Department of Education
Region ___

SCHOOL-BASED FEEDING PROGRAM (SBFP) SUMMARY OF BENEFICIARIES & START OF FEEDING

Division/Province: ______________________________________
City/ Municipality/Barangay : ____________________________
Name of School / School District : _________________________

Date of Start of Feeding: __________________________

Grade II
Nutritional Status at Start of Feeding
Number of Undernourished School
Childrenby district/School Level No. of No. of Pupils who
Severely No. of Total No. of 4 Ps are beneficiaries in
Wasted Wasted Beneficiaries Beneficiaries previous years Remarks

1 Banga East 56 25

2 Banga North 66 23

3 Banga South 23 14

4 Lake Sebu East

5 Lake Sebu West

6 Norala

7 Polomolok East

8 Polomolok West

9 Surallah Central

10 Surallah North

11 Surallah South

12 Sto. Niño
13 Tampakan

14 Tantangan

15 Tboli East

16 Tboli West

17 Tupi North

18 Tupi south

Total 56 62

Prepared by:

______________________________________
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 DepEd-HNC
 SBFP Form 3
Department of Education
Region ___

SCHOOL-BASED FEEDING PROGRAM (SBFP) SUMMARY OF BENEFICIARIES & START OF FEEDING

Division/Province: ______________________________________
City/ Municipality/Barangay : ____________________________
Name of School / School District : _________________________

Date of Start of Feeding: __________________________

Grade III
Nutritional Status at Start of Feeding
Number of Undernourished School
Childrenby district/School Level No. of No. of Pupils who
Severely No. of Total No. of 4 Ps are beneficiaries in
Wasted Wasted Beneficiaries Beneficiaries previous years Remarks

1 Banga East 65 25

2 Banga North 23

3 Banga South 32

4 Lake Sebu East

5 Lake Sebu West

6 Norala

7 Polomolok East

8 Polomolok West

9 Surallah Central

10 Surallah North

11 Surallah South

12 Sto. Niño
13 Tampakan

14 Tantangan

15 Tboli East

16 Tboli West

17 Tupi North

18 Tupi south

Total 65 80

Prepared by:

______________________________________
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 DepEd-HNC
 SBFP Form 3
Department of Education
Region ___

SCHOOL-BASED FEEDING PROGRAM (SBFP) SUMMARY OF BENEFICIARIES & START OF FEEDING

Division/Province: ______________________________________
City/ Municipality/Barangay : ____________________________
Name of School / School District : _________________________

Date of Start of Feeding: __________________________

Grade IV
Nutritional Status at Start of Feeding
Number of Undernourished School
Childrenby district/School Level No. of No. of Pupils who
Severely No. of Total No. of 4 Ps are beneficiaries in
Wasted Wasted Beneficiaries Beneficiaries previous years Remarks

1 Banga East 75 23

2 Banga North 13

3 Banga South 12

4 Lake Sebu East

5 Lake Sebu West

6 Norala

7 Polomolok East

8 Polomolok West

9 Surallah Central

10 Surallah North

11 Surallah South

12 Sto. Niño
13 Tampakan

14 Tantangan

15 Tboli East

16 Tboli West

17 Tupi North

18 Tupi south

Total 75 48

Prepared by:

______________________________________
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 DepEd-HNC
 SBFP Form 3
Department of Education
Region ___

SCHOOL-BASED FEEDING PROGRAM (SBFP) SUMMARY OF BENEFICIARIES & START OF FEEDING

Division/Province: ______________________________________
City/ Municipality/Barangay : ____________________________
Name of School / School District : _________________________

Date of Start of Feeding: __________________________

Grade IV
Nutritional Status at Start of Feeding
Number of Undernourished School
Childrenby district/School Level No. of No. of Pupils who
Severely No. of Total No. of 4 Ps are beneficiaries in
Wasted Wasted Beneficiaries Beneficiaries previous years Remarks

1 Banga East 85 44 23

2 Banga North 13 25

3 Banga South 23 26

4 Lake Sebu East

5 Lake Sebu West

6 Norala

7 Polomolok East

8 Polomolok West

9 Surallah Central

10 Surallah North

11 Surallah South

12 Sto. Niño
13 Tampakan

14 Tantangan

15 Tboli East

16 Tboli West

17 Tupi North

18 Tupi south

85 80 74
Total

Prepared by:

______________________________________
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 DepEd-HNC
 SBFP Form 3
Department of Education
Region ___

SCHOOL-BASED FEEDING PROGRAM (SBFP) SUMMARY OF BENEFICIARIES & START OF FEEDING

Division/Province: ______________________________________
City/ Municipality/Barangay : ____________________________
Name of School / School District : _________________________

Date of Start of Feeding: __________________________

Grade V
Nutritional Status at Start of Feeding
Number of Undernourished School
Childrenby district/School Level No. of No. of Pupils who
Severely No. of Total No. of 4 Ps are beneficiaries in
Wasted Wasted Beneficiaries Beneficiaries previous years Remarks

1 Banga East 63 12

2 Banga North 13

3 Banga South 14

4 Lake Sebu East

5 Lake Sebu West

6 Norala

7 Polomolok East

8 Polomolok West

9 Surallah Central

10 Surallah North

11 Surallah South

12 Sto. Niño
13 Tampakan

14 Tantangan

15 Tboli East

16 Tboli West

17 Tupi North

18 Tupi south

Total 63 39

Prepared by:

______________________________________
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 DepEd-HNC
SBFP Form 3
Department of Education
Region ___

SCHOOL-BASED FEEDING PROGRAM (SBFP) SUMMARY OF BENEFICIARIES & START OF FEEDING

Division/Province: ______________________________________
City/ Municipality/Barangay : ____________________________
Name of School / School District : _________________________

Date of Start of Feeding: __________________________

Nutritional Status at Start of Feeding

Number of Undernourished School
Children by Grade Level No. of No. of Pupils who
Severely No. of Total No. of 4 Ps are beneficiaries in
Wasted Wasted Beneficiaries Beneficiaries previous years Remarks

1. Kinder 0 119 119 0 0

2. Grade I 20 0 20 0 0

3. Grade II 56 89 145 62 0

4. Grade III 65 0 65 80 0

5. Grade IV 75 0 75 48 0

6. Grade V 85 0 85 80 74

7. Grade VI 63 0 63 39 0

Total 344 0 309 74

344

Prepared by:

______________________________________
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 DepEd-HNC
 SBFP Form 3
Department of Education
Region ___

SCHOOL-BASED FEEDING PROGRAM (SBFP) SUMMARY OF BENEFICIARIES & START OF FEEDING

Division/Province: ______________________________________
City/ Municipality/Barangay : ____________________________
Name of School / School District : _________________________

Date of Start of Feeding: __________________________

Grade VI
Nutritional Status at Start of Feeding
Number of Undernourished
School Childrenby
district/School Level No. of Pupils who
No. of Severely No. of Total No. of 4 Ps are beneficiaries in
Wasted Wasted Beneficiaries Beneficiaries previous years Remarks
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32
33
34
35

Total

Prepared by:

______________________________________
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 DepEd-HNC
SBFP Form 3
Department of Education
Region ___

SCHOOL-BASED FEEDING PROGRAM (SBFP) SUMMARY OF BENEFICIARIES & START OF FEEDING

Division/Province: ______________________________________
City/ Municipality/Barangay : ____________________________
Name of School / School District : _________________________

Date of Start of Feeding: __________________________

Nutritional Status at Start of Feeding

Number of Undernourished School
Children by Grade Level No. of Pupils who
No. of Severely are beneficiaries in
Wasted No. of Wasted Total Beneficiaries No. of 4 Ps Beneficiaries previous years Remarks

1. Kinder

2. Grade I

3. Grade II

4. Grade III

5. Grade IV

6. Grade V

7. Grade VI

Total

Prepared by:

______________________________________
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 DepEd-HNC