FORM 1

Department of Education
NCR Region

Masterlist Beneficiaries for School-Based Feeding Pr

SY 2019-2020

Province: NCR
Municipality/Barangay: Palingon-Tipas, Taguig City
School/School District: TIPAS ELEMENTARY SCHOOL-MAIN/DISTRICT CLUSTER III

DATE OF Date of Age in Weight( Height(

BIRTH Weighing/m Years/ kg) M)
(mm/dd/ easuring Months
yyyy) (mm/dd/yyy
NO. NAME GRADE/SECTION SEX y)

Prepared By:

ZOSIMA C. CARDENAS
Feeding Focal Person

This form shall be prepared by the school, to be complied by the DO, and for final compilation by the RO, for submission to DSW
ent of Education
CR Region

chool-Based Feeding Program (SBFP)

2019-2020

Name of Principal: ANGELITA C. BUENAFE

Name of Feding Person: ZOSIMA C. CARDENAS

BMI for 6 Nutritional Status 4P's ID Name of Beneficiary

y.o. & (NS) Number Parents of SBFP in
above Previous
Years
Ethnicity Disability (Yes or No)

Noted:

ANGELITA C. BUENAFE
Principal

O, for submission to DSWD-FO, copy furnished DepEd-NCR

 NUTRITIONAL STATUS REPORT
TIPAS ELEMENTARY SCHOOL-MAIN
Palingon-Tipas, Taguig City
Baseline SY 2019-2020

Date of Weighing:
Birthday Weight Height Height2
Age Body
Names mm/dd/yyyy (kg) ( meters) Sex (m2) Mass Nutritional Status
y ,m Index
Body Mass Index M F T HFA M F TOTAL
No. of Cases No. of Cases
Severely Wasted Sev. Stunted
Wasted Stunted
Normal Normal
Overweight Tall
Obese
Prepared by:

Adviser

Grade and Section

Height-For-Age
 Adviser

ade and Section