SBFP Form 1

Department of Education
Region VII

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

Division/Province: CEBU CITY/CEBU Name of Principal : MARYJEAN C. TAGAB

City/ Municipality/Barangay : CEBU CITY/SUDLON I Name of Feeding Focal Person : EMELIA C. CABILES
Name of School / School District : BITLAG INTEGRATED SCHOOL/SOUTH VII

Date of Weighing / Age in BMI for 6 Beneficiary of SBFP

No. Name Sex Date of Birth
Measuring Years /
Weight Height
y.o. and
Nutritional Ethnicity Disability 4Ps ID Name of Parents in Previous Years
(MM/DD/YYYY)
(MM/DD/YYYY) Months (Kg) (cm) above Status (NS) Number (yes or no)

1 Bacarisas, Joel M 1/1/2006 6/5/2015 9.5 16.5 1.32 12.5 Wasted Cebuano Samuel Bacarisas Yes
2 Bellita, Christian M 7/2/2007 6/5/2015 8 16.2 1.3 12.5 Wasted Cebuano Marilou Bellita Yes
3 Tana, Michael M 5/16/2003 6/5/2015 13 20.1 1.66 12.1 Wasted Cebuano Emelia Tana No
4 Abacajan, Jinky F 7/27/2008 6/5/2015 7 15.5 1.32 11.7 Wasted Cebuano Jennifer Abacajan No
5 Apatan, Russel M 1/20/2007 6/5/2015 8.5 17.3 1.32 13.11 Wasted Cebuano Adelina Apatan Yes
6 Cabiles, Jhaybert M 5//8/2007 6/5/2015 8.1 17.8 1.42 12.54 Wasted Cebuano Cheryl Cabiles Yes
7 Cabo, Crisante M 1/18/2006 6/5/2015 9.05 18 1.36 12.79 Wasted Cebuano Marilyn Cabo Yes
8 Bellita, Jevy M 7/18/2006 6/5/2015 8.11 20 1.56 12.7 Wasted Cebuano Erwin Bellita No
9 Pardillo, Justine M 2/19/2006 6/5/2015 9.04 18.2 1.25 14.5 Wasted Cebuano Juan Pardillo Yes
10 Abanto, Earl M 7/25/2002 6/5/2015 12.11 25 1.79 13.96 Wasted Cebuano Cecilia Abanto No
11 Abanto, Lester M 7/25/2002 6/5/2015 12.11 24 1.79 13.64 Wasted Cebuano Cecilia Abanto No
12 Baculi, Edcel M 3/23/2005 6/5/2015 10.3 19.8 1.46 13.56 Wasted Cebuano Maribeth Baculi No
13 Lastimosa, Jame Steven M 1/25/2004 6/5/2015 11.5 21.6 1.59 13.58 Wasted Cebuano Ma. Gina Lastimosa No
Prepared by: Noted :

EMELIA C. CABILES MARYJEAN C. TAGAB

Feeding Focal Person School Principal / Officer-in-Charge

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 DSWD-FO, copy furnished DepEd-HNC
SBFP Form 2
Department of Education
Region VII

SCHOOL-BASED FEEDING PROGRAM (SBFP)

Division/Province: CEBU CITY/CEBU
City/ Municipality/Barangay : SULON I
Name of School / School District : BITLANG INTEGRATED SCHOOL/SOUTH DISTRICT VII
Nutritional Status at Start of Feeding Ethnicity 4 Ps Beneficiaries
Number of Undernourished School
Children by Grade Level No. of Pupils who are
No. of Severely Total No. of Ethnic beneficiaries in previous
Wasted No. of Wasted Beneficiaries Ben. No. of 4 Ps Ben. years Remarks

1. Kinder 0 0 0 0 0 0

2. Grade I 0 0 0 1 0 0

3. Grade II 0 4 4 1 1 2

4. Grade III 0 2 2 1 0 1

5. Grade IV 0 3 3 1 1 2

6. Grade V 0 3 3 1 0 0

7. Grade VI 0 1 1 1 1 0

Total 0 13 13 1 3 5

Prepared by: Noted by:

EMELIA C. CABILES MARYJEAN C. TAGAB

SBFP DepEd Focal Unit Chief

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 DSWD-FO, copy furnished DepEd-HNC
SBFP Form 3
Department of Education
Region ___

SCHOOL-BASED FEEDING PROGRAM (SBFP)

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

Name of District Total

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

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 4

SCHOOL-BASED FEEDING PROGRAM

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

Page 6
 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
101 102 ### 104 105 ### ### ### ### ### 111 112 113 114 115 116 117 118 119 120 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 5
SCHOOL-BASED FEEDING PROGRAM

CONSOLIDATED NUTRITIONAL STATUS(BASELINE - ENDLINE) S.Y.:2017 - 2018)

SECONDARY
Region: VII
Division/District: CEBU CITY/SOUTH VII
School: BITLANG INTEGRATED SCHOOL
BEIS ID No.: ___________________________
NUTRITIONAL STATUS
No. of Students BEFORE PERCENTAGE
GRADES AND SECTIONS ATTENDANCE
Dewormed
SW/SU W/U N Ow Ob Total
1 GRADE 7 0 0 33 10 0 0 43
2 GRADE 8 0 0 19 14 1 0 34
3 GRADE 9 0 0 17 11 2 0 30
4 GRADE 10 0 0 5 18 1 0 24
5 GRADE 11 0 0 3 22 0 0 25
6 GRADE 12 0 0 3 21 0 0 24
7
8
9
10
11
12
13
14
15
16
17
18
19
20 TOTAL 0 0 80 96 4 0 180
AVERAGE:
Legend:
For 6-19 y.o For below 6 y.o
SW - Severely Wasted SU - Severely Underweight
W - Wasted U - Underweight
N - Normal N - Normal
Ow - Overweight Ow - Overweight
O - Obese

Prepared by: Noted by:

FLORDELIZA V. BELLITA MA. JESSICA D. BATINDAAN

School Feeding Coordinator School Head

Note: This form shall be prepared by the school using the data from SBFP Form 4.
 CONSOLIDATED NUTRITIONAL STATUS ( ENDLINE) S.Y.:2017 - 2018)
SECONDARY
Region: VII
Division/District: CEBU CITY/SOUTH VII
School: BITLANG INTEGRATED SCHOOL
BEIS ID No.: ___________________________
NUTRITIONAL STATUS
ENROLLMENT PUPILS WEIGHED
GRADES AND SECTIONS ENDLINE
MALE FEMALE TOTAL No % SW/SU W/U N Ow Ob
1 MALE 0 17 9 0 0
GRADE 7 26 12 38 38 100% FEMALE 0 4 8 0 0
TOTAL 0 21 17 0 0
2 MALE 0 5 12 1 0
GRADE 8 18 14 32 32 100% FEMALE 0 3 11 0 0
TOTAL 0 8 23 1 0
3 MALE 0 7 13 1 0
GRADE 9 21 9 30 30 100% FEMALE 0 3 5 1 0
TOTAL 0 10 19 2 0
4 MALE 0 2 11 0 0
GRADE 10 13 11 24 24 100% FEMALE 0 1 9 1 0
TOTAL 0 3 20 1 0
5 MALE 0 0 11 0 0
GRADE 11 11 14 25 25 100% FEMALE 0 2 12 0 0
TOTAL 0 2 23 0 0
6 MALE 0 1 10 0 0
7 GRADE 12 11 13 24 24 100% FEMALE 0 1 12 0 0
8 TOTAL 0 2 22 0 0
9
13
19
20 TOTAL 100 73 173 173 100% 0 46 124 4 0

Legend:
For 6-19 y.o For below 6 y.o
SW - Severely Wasted SU - Severely Underweight
W - Wasted U - Underweight
N - Normal N - Normal
Ow - Overweight Ow - Overweight
O - Obese

Prepared by: Noted by:

FLORDELIZA V. BELLITA MA. JESSICA D. BATINDAAN

Guidance Coordinator School Head