SBFP FORM 3

Department of Education
Region I

SCHOOL- BASED FEEDING PROGRAM (SBFP) SUMARY OF BENEFECIARIES & START OF FEEDING
Division/Province: LA UNION
CITY/MUNICIPALITY/BARANGAY: ARINGAY
NAME OF SCHOOL/ SCHOOL DISTRICT: SAN SIMON INTEGRATED SCHOOL ARINGAY
DATE OF START FEEDING: _____________________________

Number of Undernourished School Nutritional Status at Start of Feeding

Children by Grade Level
No. of Pupils who
No. of Severely No. of 4 Ps
No. of Wasted Total Beneficiaries are beneficiaries in Remarks
Wasted Beneficiaries
previous years
1.Kinder 3 12 15 3 0
2.Grade I 1 3 4 1 3
3. Grade II 0 1 1 1 1
4.Grade III 0 1 1 0 0
5.Grade IV 2 3 5 2 3
6.Grade V 0 1 1 0 0
7.Grade VI 1 1 2 1 1
TOTAL 7 22 29 8 8

Prepared by:

PRISCILA A. DE MESA
SBFP DepEd Focal
SBFP FORM 2
Department of Education
Region I

SCHOOL- BASED FEEDING PROGRAM (SBFP) LIST OF SCHOOLS

Division/Province: LA UNION
Name Of School/ School District: SAN SIMON INTEGRATED SCHOOL / ARINGAY

Nme of District Supervisors/

Name Of School BEIS ID NO. School Address Name Of Barangay Contact Number Total Beneficiaries
School Principal Or Oics
San Simon East, Aringay, La
San Simon Integrated School 500470 San Simon East Myrna D. Mapanao 09493430907 29
Union

Prepared by: Noted by:

PRISCILA A. DE MESA Mark Eric Amistad

SBFP DepEd Focal Unit Chief
SBFP FORM 1

Department of Education
Region I
Master School- Based Feeding Program (SBFP)

Division/Province: LA UNION Name Of Principal: MYRNA D. MAPANAO

CITY/MUNICIPALITY/BARANGAY: Aringay / San Simon Name of Feeding Focal Person: PRISCILA A. DE MESA
NAME OF SCHOOL/ SCHOOL DISTRICT: San Simon Integrated School

Date of
Beneficiary of
Weighing/ Age in BMI for 6 Participation
Date of Birth Weight Height Nutritional SBFP in
No. Name Grade Sex Measuring Years/ y.o and in 4Ps Name of Parents
(MM/DD/YYYY) (Kg) (cm) Status (NS) Previous
(MM/DD/YY Months above (yes or no)
Years
YY)

16. Justin Alexis G. Gali 1 M 08-09-2011 06-16-2017 5.10 15.5 129 11.9 Severely Wasted No Valentina Gali No
17. Lawrence Dave B. Notado 1 M 02-23-2011 06-16-2017 6.3 15.3 115 13 Wasted Yes Rebecca B. Notado Yes
18. Reymark C. Notado 1 M 02-06-2011 06-16-2017 6.4 16 125 12.8 Wasted No Reynante B. Notado Yes
19. Rose Ann G. Mercado 1 F 08-13-2011 06-16-2017 5.10 14 112 12.5 Wasted No Adrian Ghil Mercado Yes
20. Jovith C. Cobilla Jr. 2 M 09-12-2010 06-16-2017 6.9 14 107 12.86 Wasted Yes Laarni C. Cobilla Yes
21. John Lord V. Balanag 3 M 08-17-2009 06-16-2017 7.10 176 116 12.63 Wasted No Jovita Balanag No
22. Lyka Mae N. Cacananta 4 F 08-08-2008 06-16-2017 8.10 19.3 117 10.83 Severely Wasted No Tina N. Cacananta No
23. Dolly Joy C. Ibaes 4 F 12-27-2007 06-16-2017 9.5 17 116 12.42 Wasted Yes Danilo Ibaes Yes
24. Paula Benalixen A. Magno 4 F 07-26-2008 06-16-2017 8.10 17.3 117 9.63 Severely Wasted No Paul S. Magno No
25. Justin Mae Neverida 4 F 10-15-2008 06-16-2017 8.7 20.3 116 12.49 Wasted No Remy B. Neverida No
26. Erika G. Neverida 5 F 08-03-2007 06-16-2017 9.10 20 125 12.82 Wasted No William Neverida No
27. Karen Mae C. Salting 4 F 03-08-2008 06-16-2017 9.3 18 120 12.40 Wasted No Remecie Salting No
28. Jiro I. Gutay 6 M 09-28-2005 06-16-2017 10.8 21 129 12.65 Severely Wasted No Reynaldo Itang Yes
29. Rhea Joy N. Mapanao 6 F 06-30-2006 06-16-2017 10.11 25 132 14.37 Wasted Yes Joy N. Mapanao No

Prepared by:

PRISCILA A. DE MESA
SBFP DepEd Focal Person
Note: This form shall be prepared by the school, to be complied by the DO, and for final compilation by the RO, for submission to DepEd-HNC
SBFP FORM 1

Department of Education
Region I
Master List Beneficiaries for School- Based Feeding Program (SBFP)

Division/Province: LA UNION Name Of Principal: MYRNA D. MAPANAO

CITY/MUNICIPALITY/BARANGAY: Aringay / San Simon Name of Feeding Focal Person: PRISCILA A. DE MESA
NAME OF SCHOOL/ SCHOOL DISTRICT: San Simon Integrated School

Date of Beneficiary
Age in BMI for 6 Participation
Date of Birth Weighing/Meas Weight Height Nutritional of SBFP in
No. Name Grade Sex Years/ y/o and in 4Ps Name of Parents
(MM/DD/YYYY) uring (Kg) (cm) Status (NS) Previous
Months above (yes or no)
(MM/DD/YYYY) Years

1 Renz Rainier F. Balangue K M 11-27-2011 06-16-2017 5.7 18 111 14.6 Wasted No Josefina Balangue No
2 Renz F. Carreon K M 11-06-2011 06-16-2017 5.7 14 103 13.2 Wasted No Marites Carreon No
3 Eurie P. Gagarin K M 12-22-2011 06-16-2017 5.5 16 110 13.2 Severely Wasted No Leandro Gagarin No
4 Julius Cesar L. Mapalo K M 03-15-2012 06-16-2017 5.2 15 104 13.9 Wasted Yes Cecille Mapalo No
5 Josh Nathan P. Mapile K M 05-03-2012 06-16-2017 5.1 16 108 13.7 Wasted No Cebidy No
6 Ernesto C. Notado K M 03-27-2012 06-16-2017 5.2 15 103 14.1 Wasted No Reynante No
7 Reuben James M. Rulloda K M 07-31-2012 06-16-2017 4.10 15 105 13.6 Wasted No Jimmy No
8 Reian Jamiel P. Tamsi K M 10-18-2011 06-16-2017 5.7 14.2 105 12.9 Severely Wasted No Amelyn Tamsi No
9 Jessa Mae Balanag K F 01-01-2012 06-16-2017 5.9 13.4 102 12.9 Wasted No Fortunato No
10 Cherry Ann A. Calica K F 08-28-2012 06-16-2017 4.9 16.5 112 13.2 Wasted No Efren No
11 Princess A. Calica K F 08-03-2011 06-16-2017 5.10 18.5 114 14.2 Wasted No Efren No
12 Dainne Mariz C. Ibaes K F 03-20-2012 06-16-2017 5.2 11 93 12.7 Wasted Yes Danilo Ibaes No
13 Ma. Bienice N. Magno K F 12-08-2011 06-16-2017 5.6 18.3 116 13.6 Wasted No Bien Agnus Magno No
14 Lavinia Mae C. Nisperos K F 05-10-2012 06-16-2017 5.1 12.8 102 12.3 Severely Wasted Yes Vanessa No
15 Princess L. Salting K F 05-10-2012 06-16-2017 5.1 13.1 100 13.1 Wasted No Arlene No

Prepared by:

PRISCILA A. DE MESA
Feeding Focal Person
Note: This form shall be prepared by the school, to be complied by the DO, and for final compilation by the RO, for submission to DepEd-HNC