SBFP-FORM 1SBFP Form 1Department of EducationRegion ___Master List Beneficiaries for School-Based Feeding Program (SBFP)Division/Province: ______________________________________Name of Principal : ____________________________________City/ Municipality/Barangay : ____________________________Name of Feeding Focal Person : _________________________Name of School / School District : _________________________No.NameSexDate of Birth (MM/DD/YYYY)Date of Weighing / Measuring (MM/DD/YYYY)Age in Years / MonthsWeight (Kg)Height (cm)BMI for 6 y.o. and aboveNutritional Status (NS)EthnicityDisability4Ps ID NumberName of ParentsBeneficiary of SBFP in Previous Years (yes or no)Prepared by:Noted :_______________________________________________________________________Feeding Focal PersonSchool Principal / Officer-in-ChargeNote: 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 2SBFP Form 2Department of EducationRegion IIISCHOOL-BASED FEEDING PROGRAM (SBFP)Division/Province: Tarlac ProvinceCity/Municipality/Barangay: GeronaName of School/School District: Gerona NorthNumber of Undernourished School Children by Grade LevelNutritional Status at Start of FeedingEthnicity 4 Ps BeneficiariesNo. of Severely WastedNo. of WastedTotal BeneficiariesNo. of Ethnic Ben.No. of 4 Ps Ben.No. of Pupils who are beneficiaries in previous yearsRemarks1. Kinder130130002. Grade I130130003. Grade II250250534. Grade III6060115. Grade IV8080016. Grade V270270147. Grade VI15015044Total107010701113Prepared by:Noted by:VIRGINIA N. DAGUIOTEDDY M. JOSONFeeding Focal PersonPrincipal IINote: 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 3SBFP Form 3Department of EducationRegion IIISCHOOL-BASED FEEDING PROGRAM (SBFP)Division/Province: Tarlac ProvinceSchool District/City/ Municipality : Gerona NorthName of SchoolsBEIS ID No.School AddressName of BarangayName of District Supervisors/School Principal or OICsContact NumberTotal BeneficiariesGabaldon E/S106450Poblacion #3, Gerona, TarlacPoblacion #3Richard Melchor107Gerona North Central E/S106451Poblacion #3, Gerona, TarlacPoblacion #3Teddy Joson9477511786107Prepared by:Noted by:VIRGINIA N. DAGUIOTEDDY M. JOSONFeeding Focal PersonPrincipal IINote: 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 (1)SBFP Form 4SCHOOL-BASED FEEDING PROGRAMFOR THE MONTH OF ______________________ , SY _____________Region ____________________________Division ___________________________School: _____________________________________District ___________________________Grade: __________ Section _____________________NAME OF PUPIL4Ps Beneficiary (y or n)Beneficiary of Previous SBFP (y or n)PRE FEEDINGACTUAL FEEDINGAgeBirth DateSexNutritional StatusDewormingHtWtDateNS( ) or (X)DatecmkgTakenTaken123456789101112131415161718192012345678910111213141516171819202122232425TOTAL:Prepared by:L E G E N D____________________________A. Nutritional StatusB. DewormingD. Actual FeedingFeeding Teacher / School NurseFor 6-19 y.oFor below 6 y.oSW - Severely wastedSU - Severely underweight( x ) - not dewormed( ) - Present, servedW - WastedU - Underweight( ) - dewormed( A ) - Absent, not servedN - NormalN - Normal( ) - Present, served twiceOw - OverwieghtOw - OverwieghtO - ObeseNote: This form shall be prepared by the school to be consolidated using SBFP Form 5

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SBFP-FORM 4 (2)SBFP Form 4SCHOOL-BASED FEEDING PROGRAMFOR THE MONTH OF ______________________ , SY _____________Region ____________________________Division ___________________________School: _____________________________________District ___________________________Grade: __________ Section _____________________NAME OF PUPILACTUAL FEEDING2122232425262728293031323334353637383940414243444546474849505152535455565758596012345678910111213141516171819202122232425TOTAL:D. Actual Feeding( ) - Present, served( A ) - Absent, not served( ) - Present, served twice

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SBFP-FORM 4 (3)SBFP Form 4SCHOOL-BASED FEEDING PROGRAMFOR THE MONTH OF ______________________ , SY _____________Region ____________________________Division ___________________________School: _____________________________________District ___________________________Grade: __________ Section _____________________NAME OF PUPILACTUAL FEEDING61626364656667686970717273747576777879808182838485868788899091929394959697989910012345678910111213141516171819202122232425TOTAL:D. Actual Feeding( ) - Present, served( A ) - Absent, not served( ) - Present, served twice

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SBFP-FORM 4 (4)SBFP Form 4SCHOOL-BASED FEEDING PROGRAMFOR THE MONTH OF ______________________ , SY _____________Region ____________________________Division ___________________________School: _____________________________________District ___________________________Grade: __________ Section _____________________NAME OF PUPILACTUAL FEEDINGPOST FEEDINGATTENDANCENutritional StatusDays PresentFeeding DaysPercentageHtWtDate101102103104105106107108109110111112113114115116117118119120cmkgTakenNS(A)(B)(A/B)*10012345678910111213141516171819202122232425TOTAL:AVERAGE:D. Actual Feeding( ) - Present, served( A ) - Absent, not served( ) - Present, served twice

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SBFP-FORM 5SBFP Form 5SCHOOL-BASED FEEDING PROGRAMCONSOLIDATED NUTRITIONAL STATUS AND ATTENDANCE REPORTRegion: _______Division/District: ________________________School: ________________________________BEIS ID No.: ___________________________GRADES AND SECTIONSNo. of Pupils DewormedNUTRITIONAL STATUSPERCENTAGE ATTENDANCEBEFOREAFTERSW/SUW/UNOwObTotalSW/SUW/UNOwOTotal111234567891011121314151617181920TOTALAVERAGE:Legend:For 6-19 y.oFor below 6 y.oSW - Severely WastedSU - Severely UnderweightW - WastedU - UnderweightN - NormalN - NormalOw - OverweightOw - OverweightO - ObesePrepared by:Noted by:________________________________________________________Classroom Adviser / School NurseSchool HeadNote: This form shall be prepared by the school using the data from SBFP Form 4.