SBFP Form 1 (2020)

Department of Education
Region ___

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 : _________________________
School ID Number: _________________________

BMI for Nutritional Participation Beneficiary of SBFP

Grade/ Date of Birth Date of Weighing / Age in Weight Height 6 y.o. Status (NS)
No. Name Sex Section (MM/DD/YYYY)
Measuring Years / in 4Ps in Previous Years
(MM/DD/YYYY) Months (Kg) (cm) and
(yes or no) (yes or no)
above
BMI-A HFA

Prepared by: Approved by:

__________________________________ School Head

Feeding Focal Person

Note: This form shall be prepared by the school before the start of feeding to be compiled by the SDO.
SBFP Form 2 (2020)
Department of Education
Region ___

SCHOOL-BASED FEEDING PROGRAM (SBFP) LIST OF SCHOOLS

Division/Province: ______________________________________
School District/City/ Municipality : ____________________________

Name of District
Contact Number or & Total
Name of Schools BEIS ID No. School Address Name of Barangay Supervisors/
Email Address Beneficiaries
School Principal or OICs

Prepared by: Approved by:

SBFP DepED Focal Unit Chief

Note: This form shall be prepared by the SDO before the start of feeding, for final consolidation by the RO.
SBFP Form 3 (2020)
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 : _________________________
School ID Number: _________________________
Date of Start of Feeding: __________________________

Nutritional Status at Start of Feeding No. of 4 Ps No. of Pupils who Remarks

Beneficiaries are beneficiaries in
Number of Undernourished School No. of No. of Total No. of No. of Total SS+S previous years
Children by Grade Level Severely Wasted SW+W Severely Stunted
Wasted Stunted

1. Kinder

2. Grade I

3. Grade II

4. Grade III

5. Grade IV

6. Grade V

7. Grade VI

Total

Prepared by: Approved by:

______________________________________
SBFP DepEd Focal School Head

Note: This form shall be prepared by the school before the start of feeding, to be compiled by the SDO, and for final compilation by the RO, for submission to DepEd
BLSS-SHD
 SBFP Form 4 (2020)
SCHOOL-BASED FEEDING PROGRAM
RECORD OF DAILY FEEDING

FOR THE MONTH OF ______________________ , SY _____________

Region ____________________________
Division ___________________________ School: _____________________________________
District ___________________________ Grade: __________ Section _____________________
School ID Number: _________________________
NAME OF PUPIL 4Ps Beneficiary PRE FEEDING ACTUAL FEEDING
Beneficiary of Previous
(y or n) SBFP Age Birth Sex Nutritional Status Deworming
(y or n)
Date
Ht Wt Date NS (√ ) or Date
(cm) (kg) Taken BMI-A HFA (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 For 3-19 y.o
SW - Severely wasted SU - Severely underweight SS - Severely Stunted ( x ) - not dewormed (H ) - Present, served with Hot meals
Approved by: W - Wasted U - Underweight S - Stunted ( √ ) - dewormed (M ) - Present, served with Milk
N - Normal N - Normal N - Normal (H/M ) - Present, served with Hot meals & Milk
Ow - Overwieght Ow - Overwieght T - Tall ( A ) - Absent, not served
School Head O - Obese (H2/M2/(H/M2)) - Present, served twice

Note: This form shall be prepared by the school to be consolidated using the Revised OKD Form A.
Page 4
 SBFP Form 4 (2020)

SCHOOL-BASED FEEDING PROGRAM

FOR THE MONTH OF ______________________ , SY _____________

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

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

(H ) - Present, served with Hot meals

(M ) - Present, served with Milk
(H/M ) - Present, served with Hot meals & Milk
( A ) - Absent, not served
(H2/M2/(H/M2)) - Present, served twice

page 2
 SBFP Form 4 (2020)

SCHOOL-BASED FEEDING PROGRAM

FOR THE MONTH OF ______________________ , SY _____________

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

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

(H ) - Present, served with Hot meals

(M ) - Present, served with Milk
(H/M ) - Present, served with Hot meals & Milk
( A ) - Absent, not served
(H2/M2/(H/M2)) - Present, served twice

page 3
 SBFP Form 4 (2020)

SCHOOL-BASED FEEDING PROGRAM

FOR THE MONTH OF ______________________ , SY _____________

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

ACTUAL FEEDING POST FEEDING

ATTENDANCE
NAME OF PUPIL No. of No. of
Nutritional Status Days Feeding Percentage
Ht Wt Date NS Present Days
101 102 103 104 105 106 107 108 109 110 111 112 113 114 115 116 117 118 119 120 cm kg Taken BMI-A HFA (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

(H ) - Present, served with Hot meals

(M ) - Present, served with Milk
(H/M ) - Present, served with Hot meals & Milk
( A ) - Absent, not served
(H2/M2/(H/M2)) - Present, served twice

page 4
SBFP Form 5 (2020)

DEPARTMENT OF EDUCATION
Region ____

REGION/DIVISION/DISTRICT: ____________________________________________________________________
NAME OF SCHOOL: ____________________________________________________________________
SCHOOL ID NO.: ____________________________________________________________________

SCHOOL-BASED FEEDING PROGRAM - MILK COMPONENT

LIST OF AUTHORIZED CONSIGNEES

NAME & DESIGNATION TEL. NO. MOBILE NO. EMAIL ADD SPECIMEN
SIGNATURE
1 (School Head)

2 (School Feeding Coordinator)

3 (School Property Custodian)

Note: This form shall be filled-up by School Drop-off points to be given to the NDA/Dairy Cooperative supplier on the first
delivery of milk. Only authorized consignees are allowed to receive the goods.
SBFP Form 5 (2020)
SBFP Form 6 (2020)

DEPARTMENT OF EDUCATION
Region ___

REGION/DIVISION/DISTRICT: ___________ VIII -CALBAYOG CITY- TINAMABACAN III

NAME OF SCHOOL: ______ PEŇA I ELEMENTARY SCHOOL
SCHOOL ID NO.: ____ 124139

SCHOOL-BASED FEEDING PROGRAM - MILK COMPONENT

LIST OF BENEFICIARIES
Classification of Students in terms of Milk Tolerance
(Please check one)
Without milk With milk Not allowed by
intolerance and will intolerance but parents to
Name Grade & Section
participate in milk willing to participate in milk
feeding participate in milk feeding
feeding
       ALBASIN, RANZEL, S. KINDER-JADE /
PUGOSO, RONXANYIER, V. KINDER-JADE /
AVENIDO, ALFRED JAMES P. KINDER-OPAL /
CANELAS, ROMAR A. KINDER-OPAL /
GALECIA, CYRIL E. KINDER-OPAL /
SALVADOR, CJ, M. KINDER-JADE /
VILLA, JUDE WESLEY E. KINDER-OPAL /
  ESTADO, RONIEL A. KINDER-OPAL /
  MESA, PRINCE ARVIN G. KINDER-JADE /
     RENTILLOSA, CELJOHN, M. KINDER-JADE /
     COMPACION, ANGELO F. KINDER-JADE /
     COMPACION, REYMART A. KINDER-OPAL /
      LABISTO, JAY MAR, D. KINDER-OPAL /
      ALIPOGPOG, ARNIEL C. KINDER-OPAL /
      ALLEGO, KENLY R. KINDER-OPAL /
      ESTADO, RONIEL E. KINDER-OPAL /
      GERALDEZ, EL JHON, B. KINDER-JADE /
       MARIBOJOC, CRISTOPHER C. KINDER-JADE /
       ACOPIADO, KIM- JAY C. KINDER-JADE /
        MANALESE, GIN HEART C. KINDER-JADE /
        ALBASIN, RICHARD, S. KINDER-JADE /
ABEJUELA, JHON CARLO A. KINDER-OPAL /
JALAYAJAY, ROSTUM T. KINDER-OPAL /
MASIGA, KHEN L. KINDER-JADE /
MESA, PRINCE RV. G. KINDER-OPAL /
MILLARA, JHANREY M. KINDER-JADE /
MONTIVEZ, RENZ JAMES M. KINDER-JADE /
MONZALES, JHELO C. KINDER-OPAL /
ROJAS, PATRICK JHERO R. KINDER-OPAL /
        ARMENION, MYRIEL ZAKIA, M. KINDER-JADE /
        BARBOLINO, METESHA, M. KINDER-JADE /
       BORINAGA, KEMCHI, B. KINDER-JADE /
      CASPE, EMALYN P. KINDER-JADE /
       CASPE, RUEZILLE L. KINDER-JADE /
        EBAJO, TRISHA, C. KINDER-JADE /
     FIGUEROA, JUSLYN E. KINDER-JADE /
   MENDOZA, RONALYN, L. KINDER-JADE /
       MONTIMOR, AIRA, A. KINDER-JADE /
     MONTIMOR, AIZA MIE, A. KINDER-JADE /
    PESQUIRA, CRYSTAL EVE V. KINDER-JADE /
    RONDA, FREYA ROSE M. KINDER-JADE /
     SANTOS, ALTHEA ELCIA R. KINDER-JADE /
    SINOLOS, MA. JAIME D. KINDER-JADE /
SBFP Form 6 (2020)

    TRANGIA, NICOLE, T. KINDER-JADE /

  TOOL, MARIELYN J. KINDER-JADE /
       ABACHAR, ANGELICA L. KINDER-OPAL /
       ALVARADO, ERAMIE U. KINDER-OPAL /
       ARELLANO, SANDRA J. KINDER-OPAL /
      BALBOA, AHMBER DAWN B. KINDER-OPAL /
    BALLERO, JESSIECA A. KINDER-OPAL /
      BITAMOR, CLARISSA ROSE B. KINDER-OPAL /
    BORINAGA, CHINNA B. KINDER-OPAL /
     CASPE, PRINCESS KYLE T. KINDER-OPAL /
  ESPINOSA, QUEEN JEANNA M. KINDER-OPAL /
  MAPA, ARIANA Q. KINDER-OPAL /
  MERCADER, JESLYN C. KINDER-OPAL /
  MONTIMOR, ZIA TYRA M. KINDER-OPAL /
  PUZON, HANNAH ROSE D. KINDER-OPAL /
TAMIDLES, SOPHIA DANNE C. KINDER-OPAL /
  TAMIDLES, WINDELYN M. KINDER-OPAL /
DELA CRUZ, CLARK JHON M. G-1- QUARTZ /
SENOLOS, VIVENCIO JR. C. G-1- QUARTZ /
MAHUSAY, ROELYN M. G-1- JASPER /
PROBADORA, LORNA L. G-1- JASPER /
TAPAYA, MAIKA R. G-1- JASPER /
GERALDEZ, ELMER JR. B. G-2- CITRINE /
CAŇELAS, JULIA A. G-2- CARNELIAN /
ESTILLANA, JACKILYN P. G-2- AMBER /
LUVETANIA, JONEL A. G-3- ZIRKON /
MAHUSAY, DHIAN R. G-3- ZIRKON /
BARBOLINO, WELBUR M. G-3- ZIRKON /
FARO, MA. YVONE G. G-4- MOONSTONE /
MONTIMOR, ALEXIS A. G-4- MOONSTONE /
REYES, KAREN D. G-4- MOONSTONE /
ARANZADO, JIMBOY C. G- 5- EMERALD /
CANTIGA, KIMBERLYN S. G- 5- EMERALD /
GALECIA, GELYN E. G- 5- EMERALD /
SUAREZ, HIEZELLE F. G-6- GARNET /
ORILLANO, JOHN FLORENCE G. G-6- TAFFELIT /
TOOL, DENNIS E. G-6- GARNET /
Prepared by: APPROVED BY:

FLORELIN F. DUMALAG MICHAEL S. BUENAVENTURA

School Feeding Coordinator School Head
SBFP Form 7 (2020)

DEPARTMENT OF EDUCATION
Region ___

SCHOOL-BASED FEEDING PROGRAM MONTHLY/QUARTERLY REPORT

Region/Division: ____________________

Financial Status
Status of Implementation
(when Status of
Target No. Actual No. % Liquidation
No. of SDO started, completed, Amount downloading of
Division/Schools of SBFP of SBFP Remarks
Schools (SBFP discontinue, for Amount Downloaded funds to Schools
Schools Schools Schools/SDO Disbursed
Schools) continuation or number of Allocated /Received (Amount
feeding days completed) (SDOs) downloaded to 1st 2nd
schools)

Prepared by: Approved by:

RO/SDO Focal Person Regional Director/ Schools Division Superintendent

RO/SDO Accountant