SBFP Form 1

Department of Education
Region 02
Master List Beneficiaries for School-Based Feeding Program (SBFP)
Division/Province: ISABELA Name of Principal : SAHLEE E. MIGUEL
City/ Municipality/Barangay : QUIRINO/ LUNA Name of Feeding Focal Person : JEAN ROSE B. LAMORENA
Name of School / School District : LUNA-SUERTE ES / QUIRINO DISTRICT
Grade Participation Beneficiary of SBFP in
Date of Weighing / Age in Weight Height BMI for 6 y.o. and Nutritional in 4Ps
Date of Birth
No. Name Sex Measuring Years / Name of Parents Previous Years (yes or
(MM/DD/YYYY)
(MM/DD/YYYY) Months (Kg) (cm) above Status (NS) (yes or no)
Level no)
1 Cabal, Angel Mae K F 3/9/2012 6/21/2017 63 12.3 1.03 SW no Joebemard Cabel no
2 Asuncion. Ivory K F 7/7/2011 6/21/2017 71 13.5 1.05 SW no Ruperto Asuncion no
3 Ballesteros, Ella Mae K F 12/28/2011 6/21/2017 65 14.3 1.04 W no Ana Mae Lauricio no
4 Laverinto, Leonard 1 M 5/7/2011 6/21/2017 6.1 13 1.07 11.3 SW no Ferdinand Laverinto yes
5 Abon, Jaspher 1 M 3/28/2010 6/21/2017 7.2 15 1.1 12.3 W no Joe Darwin Abon yes
6 Talledo, Mark Well 1 M 11/24/2009 6/21/2017 7.6 15 1.1 12.3 W no Laurene Talledo yes
7 Andres, Queen Stephanie 1 F 1/1/2011 6/21/2017 6.5 15.8 1.12 12.5 W no Merlin Andres yes
8 Lamorena, Jose Nathaniel 2 M 4/28/2010 6/21/2017 7.1 17.5 1.18 12.50 W no Reymunda Lamorena yes
9 Valentino, Althea Mae 4 F 5/8/2007 6/21/2017 10.1 22.4 1.18 12.80 W no Alberto Valentino no
10 Julian, Amelia Rose 5 F 9/15/2006 6/21/2017 10.9 26.1 1.38 13.7 W yes Roger Julian no
11 Santiago, Airezel 5 F 2/7/2007 6/21/2017 10.4 24.4 1.38 12.8 W no Jomar Santiago yes
12 Flores, Rey Mark 6 M 5/5/2006 6/21/2017 11.1 24.8 1.34 13.8 W no Rodrigo Flores yes
13 Julian, Darel 6 M 7/3/2005 6/21/2017 11.11 26.3 1.36 14.2 W yes Dario Julian yes

Prepared by:

JEANROSE B. LAMORENA
Feeding Focal Person

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 DepEd-HNC
SBFP Form 2
Department of Education
Region:02

SCHOOL-BASED FEEDING PROGRAM (SBFP)

Division/Province: Isabela
School District/City/ Municipality : Quirino

Name of District Total

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

LUNA-SUERTE ELEMENTARY SCHOOL 103578 LUNA QUIRINO ISABELA LUNA SAHLEE E.MIGUEL 9175765722 13

Prepared by: Noted by:

JEANROSE B. LAMORENA SAHLEE E. MIGUEL

SBFP Focal Person Principal I

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 3
Department of Education
Region 02

SCHOOL-BASED FEEDING PROGRAM (SBFP) SUMMARY OF BENEFICIARIES & START OF FEEDING

Division/Province: ISABELA
City/ Municipality/Barangay : QUIRINO / LUNA
Name of School / School District : ____ LUNA-SUERTE ELEM. SCHOOL / QUIRINO DISTRICT
Date of Start of Feeding: August 14, 2017

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 No. of Wasted No. of Ethnic No. of 4 Ps beneficiaries in
Remarks
Wasted Total Beneficiaries Beneficiaries Beneficiaries previous years

1. Kinder 2 1 3 0 0 0

2. Grade I 1 3 4 0 0 4

3. Grade II 0 1 1 0 0 1

4. Grade III 0 0 0 0 0 0

5. Grade IV 0 1 1 0 0 0

6. Grade V 0 2 2 0 1 1

7. Grade VI 0 2 2 0 1 2

Total 3 10 13 0 2 8

Prepared by:

JEANROSE B. LAMORENA
SBFP DepEd Focal

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 DepEd-HNC
 SBFP Form 4
SCHOOL-BASED FEEDING PROGRAM
RECORD OF DAILY FEEDING
Region: 02
Division: ISABELA School: LUNA-SUERTE ELEM. SCHOOL
District: QUIRINO Grade: K TO 6

4Ps ACTUAL FEEDING

Grade PRE FEEDING
Benefi
NAME OF PUPIL ciary Nutritional Status Deworming
(y or Ht Wt Date Date
n)
Level Age Sex (√ ) or
NS
Birth 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 Cabal, Angel Mae no K 63 3/9/2012 F 1.03 12.3 6/21/2017 SW / 7/21/2017
2 Asuncion. Ivory no K 71 7/7/2011 F 1.05 13.5 6/21/2017 SW / 7/21/2017
3 Ballesteros, Ella Mae no K 65 12/28/2011 F 1.04 14.3 6/21/2017 W / 7/21/2017
4 Laverinto, Leonard no 1 6.1 5/7/2011 M 1.07 13 6/21/2017 SW / 7/21/2017
5 Abon, Jaspher no 1 7.2 3/28/2010 M 1.1 15 6/21/2017 W / 7/21/2017
6 Talledo, Mark Well no 1 7.6 11/24/2009 M 1.1 15 6/21/2017 W / 7/21/2017
7 Andres, Queen Stephanie no 1 6.5 1/1/2011 F 1.12 15.8 6/21/2017 W / 7/21/2017
8 Lamorena, Jose Nathaniel no 2 7.1 4/28/2010 M 1.18 17.5 6/21/2017 W / 7/21/2017
9 Valentino, Althea Mae no 4 10 5/8/2007 F 1.18 22.4 6/21/2017 W / 7/21/2017
10 Julian, Amelia Rose yes 5 11 9/15/2006 F 1.38 26.1 6/21/2017 W / 7/21/2017
11 Santiago, Airezel no 5 10 2/7/2007 F 1.38 24.4 6/21/2017 W / 7/21/2017
12 Flores, Rey Mark no 6 11 5/5/2006 M 1.34 24.8 6/21/2017 W / 7/21/2017
13 Julian, Darel yes 6 11 7/3/2005 M 1.36 26.3 6/21/2017 W / 7/21/2017
TOTAL:
Prepared by:
LEGEND
JEANROSE B. LAMORENA A. Nutritional Status
B. Deworming D. Actual Feeding
Feeding Teacher 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

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

Page 4
 SBFP Form 4

SCHOOL-BASED FEEDING PROGRAM

RECORD OF DAILY FEEDING

Region: 02
Division: ISABELA School: LUNA-SUERTE ELEM. SCHOOL
District: QUIRINO Grade: K TO 6

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 Cabal, Angel Mae
2 Asuncion. Ivory
3 Ballesteros, Ella Mae
4 Laverinto, Leonard
5 Abon, Jaspher
6 Talledo, Mark Well
7 Andres, Queen Stephanie
8 Lamorena, Jose Nathaniel
9 Valentino, Althea Mae
10 Julian, Amelia Rose
11 Santiago, Airezel
12 Flores, Rey Mark
13 Julian, Darel
TOTAL:

D. Actual Feeding

( √ ) - Present, served
( A ) - Absent, not served
(√√ ) - Present, served twice

page 2
 SBFP Form 4

SCHOOL-BASED FEEDING PROGRAM

RECORD OF DAILY FEEDING

Region: 02
Division: ISABELA School: LUNA-SUERTE ELEM. SCHOOL
District: QUIRINO Grade: K TO 6

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 Cabal, Angel Mae
2 Asuncion. Ivory
3 Ballesteros, Ella Mae
4 Laverinto, Leonard
5 Abon, Jaspher
6 Talledo, Mark Well
7 Andres, Queen Stephanie
8 Lamorena, Jose Nathaniel
9 Valentino, Althea Mae
10 Julian, Amelia Rose
11 Santiago, Airezel
12 Flores, Rey Mark
13 Julian, Darel
TOTAL:

D. Actual Feeding

( √ ) - Present, served
( A ) - Absent, not served
(√√ ) - Present, served twice

page 3
 SBFP Form 4

SCHOOL-BASED FEEDING PROGRAM

RECORD OF DAILY FEEDING
Region: 02
Division: ISABELA School: LUNA-SUERTE ELEM. SCHOOL
District: QUIRINO Grade: K TO 6

ACTUAL FEEDING POST FEEDING

ATTENDANCE
NAME OF PUPIL Nutritional Status Days Feeding
Percentage
Ht Wt Date 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 NS (A) (B) (A/B)*100
1 Cabal, Angel Mae
2 Asuncion. Ivory
3 Ballesteros, Ella Mae
4 Laverinto, Leonard
5 Abon, Jaspher
6 Talledo, Mark Well
7 Andres, Queen Stephanie
8 Lamorena, Jose Nathaniel
9 Valentino, Althea Mae
10 Julian, Amelia Rose
11 Santiago, Airezel
12 Flores, Rey Mark
13 Julian, Darel
TOTAL: AVERAGE:

D. Actual Feeding

( √ ) - Present, served
( A ) - Absent, not served
(√√ ) - Present, served twice

page 4
SBFP Form 5
SCHOOL-BASED FEEDING PROGRAM

CONSOLIDATED NUTRITIONAL STATUS AND ATTENDANCE REPORT

AS OF AUGUST 31, 2017
Region: 02
Division/District: Isabela/Quirino
School: Luna-Suerte Elem. School
BEIS ID No.: 103578
NUTRITIONAL STATUS
GRADES AND SECTIONS Date of Birth
SEX Age Height Weight BMI NS SW/SU W/U N Ow O Total
1 Cabal, Angel Mae 3/9/2012 F 65 1.03 12.3 severely underweight /
2 Asuncion. Ivory 7/7/2011 F 6.1 1.06 13.6 12.10 wasted /
3 Ballesteros, Ella Mae 12/28/2011 F 68 underweight /
4 Laverinto, Leonard 5/7/2011 M 6 3 1.07 13.2 11.50 Severely Wasted /
5 Abon, Jaspher 3/28/2010 M 7 5 1.1 15.1 12.40 Wasted /
6 Talledo, Mark Well 11/24/2009 M 7 9 1.1 15.5 12.80 Wasted /
7 Andres, Queen Stephanie 1/1/2011 F 6 7 1.12 15.8 12.50 Wasted /
8 Lamorena, Jose Nathaniel 4/28/2010 M 7 4 1.18 17.6 12.60 Wasted /
9 Valentino, Althea Mae 5/8/2007 F 10 3 1.19 22.7 16.00 Normal /
10 Julian, Amelia Rose 9/15/2006 F 10 11 1.39 26.1 13.50 Wasted /
 11 Santiago, Airezel 2/7/2007 F 10 6 1.39 24.5 12.60 Wasted /
12 Flores, Rey Mark 5/5/2006 M 11 3 1.34 24.9 13.80 Wasted /
13 Julian, Darel 7/3/2005 M 12 1 1.37 26.5 14.10 Wasted /
TOTAL 2 10 1 0 0 13
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:
SAHLEE E. MIGUEL
TERESITA C. HERNANDO School Head

Note: This form shall be prepared by the school using the data from SBFP Form 4.
PERCENTAGE
ATTENDANCE

100%
100%
100%
100%
100%
100%
100%
100%
100%
100%
100%
100%
100%
100%
 SBFP Form 5

SCHOOL-BASED FEEDING PROGRA

CONSOLIDATED NUTRITIONAL STATUS AND ATT

AS OF SEPTEMBER 29, 2017

Region: 02
Division/District: Isabela/Quirino
School: Luna-Suerte Elem. School
BEIS ID No.: 103578
NUTRITIONAL S
GRADES AND SECTIONS Date of Birth
SEX Age Height Weight BMI

1Cabal, Angel Mae 3/9/2012 F 66 1.04 12.4

2Asuncion. Ivory 7/7/2011 F 6.2 1.06 13.6 12.10
3Ballesteros, Ella Mae 12/28/2011 F 69
4Laverinto, Leonard 5/7/2011 M 6 3 1.08 13.5 11.50
5Abon, Jaspher 3/28/2010 M 7 5 1.1 15.4 12.70
6Talledo, Mark Well 11/24/2009 M 7 9 1.1 15.5 12.80
7Andres, Queen Stephanie 1/1/2011 F 6 7 1.14 15.8 12.10
8Lamorena, Jose Nathaniel 4/28/2010 M 7 4 1.19 17.8 12.50
9Valentino, Althea Mae 5/8/2007 F 10 3 1.19 22.8 16.10
###Julian, Amelia Rose 9/15/2006 F 10 11 1.4 26.2 13.30
###Santiago, Airezel 2/7/2007 F 10 6 1.39 24.5 12.60
###Flores, Rey Mark 5/5/2006 M 11 3 1.34 24.9 13.80
###Julian, Darel 7/3/2005 M 12 1 1.38 26.7 14.00
TOTAL
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:

TERESITA C. HERNANDO

Note: This form shall be prepared by the school using the data from SBFP Form 4.
ASED FEEDING PROGRAM

AL STATUS AND ATTENDANCE REPORT

EPTEMBER 29, 2017

NUTRITIONAL STATUS
PERCENTAGE
ATTENDANCE
NS SW/SU W/U N Ow O Total

severely underweight
/ 100%
wasted / 100%
underweight / 100%
Severely Wasted / 100%
Wasted / 100%
Wasted / 100%
Wasted / 100%
Wasted / 100%
Normal / 100%
Wasted / 100%
Wasted / 100%
Wasted / 100%
Wasted / 100%
2 10 1 0 0 13 100%

SAHLEE E. MIGUEL
School Head