SBFP Form 1 (2021)
Department of Education
Region XIII
Master List Beneficiaries for School-Based Feeding Program (SBFP) (SY 2022-2023)
Division/Province: AGUSAN DEL SUR Name of Principal : DULCE AMOR C. PAWAY
City/ Municipality/Barangay : ESPERANZA/ ANOLINGAN Name of Feeding Focal Person : ROSE MAE C. PAWAY
Name of School / School District : ANOLINGAN IS/ ESPERANZA DISTRICT II
School ID Number: 501294 October 17, 2022
Nutritional Parent's Particip
Age in BMI for Deworme consent ation in Beneficiary of
Date of Weighing / Weight Height 6 y.o. Status (NS)d?
No. Name Sex Grade/ Section Date of Birth Measuring Years / for milk? 4Ps SBFP in
(MM/DD/YYYY)
(MM/DD/YYYY) Months (Kg) (cm) and (yes or Previous Years
above no) (yes or no) (yes or (yes or no)
BMI-A HFA no)
1 Cañedo, Scarliet G. M Kindergarten 04/30/2017 08/29/2022 63 15.5 102 N N YES YES NO NO
2 Coreses, Kevin Rey C. M Kindergarten 10/28/2017 08/29/2022 58 15 102 N N YES YES NO NO
3 Lagura,Kian Cyron S. M Kindergarten 05/24/2017 08/29/2022 63 16 105 N N YES YES NO NO
4 Limpot, Lorenz P. M Kindergarten 08/19/2017 08/29/2022 60 14.5 102 N N YES YES NO NO
5 Madrelijos, Ethan B. M Kindergarten 10-11-2017 08/29/2022 58 16.2 103 N N YES YES NO NO
6 Mahinay, Josshua U. M Kindergarten 10-12-2017 08/29/2022 58 16.8 102 N N YES YES NO NO
7 Manatad, Rodel P. M Kindergarten 05-02-2017 08/29/2022 63 15 102 N N YES YES NO NO
8 Mendoza, Junrey C. M Kindergarten 05-31-2017 08/29/2022 62 18 105 N N YES YES NO NO
9 Morales, April Jhon P. M Kindergarten 04-24-2017 08/29/2022 64 13.2 101 W S YES YES NO NO
10 Ompad,Jhon Dave F. M Kindergarten 05-31-2017 08/29/2022 62 16 103 N N YES YES NO NO
11 Palagnas,Harly John Y. M Kindergarten 01-31-2017 08/29/2022 66 15.5 104 N N YES YES NO NO
12 Panotsol, Jan Kevin M. M Kindergarten 06-23-2017 08/29/2022 62 16.6 107 N N YES YES NO NO
13 Prajes, Xean Harvie B. M Kindergarten 03-23-2017 08/29/2022 65 17 105 N N YES YES NO NO
14 Ruaza,Charli P. M Kindergarten 09-05-2015 08/29/2022 69 19 110 N N YES YES NO NO
15 Sumuguid, Ranelle B. M Kindergarten 11-14-2016 08/29/2022 7 , 7 23.5 120 16.30 N N YES YES NO NO
16 Umpad, John Dave L. M Kindergarten 01-21-2015 08/29/2022 9 , 1 19 111 15.40 N S YES YES NO NO
17 Umpad, John Paul L. M Kindergarten 07-02-2013 08/29/2022 60 19.1 104 N N YES YES NO NO
18 Acaac,Jorelie Mae B. F Kindergarten 08-10-2017 08/29/2022 61 18.5 110 N N YES YES NO NO
19 Arro,Babylyn S. F Kindergarten 07-09-2017 08/29/2022 63 12.3 0.96 SW S YES YES NO NO
20 Bacor,Gracelee B. F Kindergarten 04-30-2017 08/29/2022 69 16 107 N N YES YES NO NO
21 Banate,Merry Grace B. F Kindergarten 11-17-2016 08/29/2022 68 13.4 105 W N YES YES NO NO
22 Morales, Venice Llianne S. F Kindergarten 07-16-2017 08/29/2022 61 15.5 100 N S YES YES NO NO
23 Ruaza,Cailyn Joy - F Kindergarten 08-04-2017 08/29/2022 60 14.5 100 N N YES YES NO NO
24 Seguisa, Lady Fay - F Kindergarten 12-29-2016 08/29/2022 7 , 3 19 110 15.70 N S YES YES NO NO
25 Canino, Kint Joy P. M Grade 1 01/05/2016 08/29/2022 6 , 7 15.7 114 12.00 SW N YES YES NO NO
26 Samiliano,Clark Arkin - M Grade 3-A 05-31-2014 08/29/2022 8 , 2 18 117 13.1 W N YES YES NO NO
27 Solibar, John Mark M. M Grade 4 08-30-2012 08/29/2022 9 , 11 19 123 12.50 SW S YES YES NO NO
28 Cabatuan, Ellerie R. F Grade 4 06-28-2013 08/29/2022 9 , 2 17 119 12.00 SW S YES YES NO NO
29 Lacno, Hannah Jane S. F Grade 4 06/10/2012 08/29/2022 9 , 10 20 130 11.80 SW N YES YES YES NO
30 Asidoy, Rechel Mae G. F Grade 4 05-28-2013 08/29/2022 9 , 3 17 1.14 13.00 W SS YES YES NO NO
31 Genelza, Claudith D. F Grade 4 10-18-2012 08/29/2022 9 , 10 20.5 1.27 12.70 W N YES YES NO NO
32 Babao, Axel Jhames O. M Grade 5 05-22-2012 08/29/2022 10 , 3 21 1.29 12.60 SW N YES YES YES YES
33 Cañedo, Xiann Phil V. M Grade 5 02-23-2012 08/29/2022 10 , 6 17 1.32 9.70 SW N YES YES YES NO
34 Bornea, Dave Earl Jhon M. M Grade 5 10-18-2011 08/29/2022 10 , 10 29 1.45 13.70 W N YES YES NO NO
35 Almendras, Rodrilyn M. F Grade 5 9/6/2012 08/29/2022 10 , 2 22 1.29 13.20 W N YES YES NO YES
36 Sadia, Dash Lee F. M Grade 6 12/8/2010 08/29/2022 12 , 0 23 1.26 14.40 W SS YES YES NO YES
Prepared by: Approved by:
(COUNTER SIGN Nurse)
ROSE MAE C. PAWAY DULCE AMOR C. PAWAY
Feeding Focal Person Principal II
Note: This form shall be prepared by the school before the start of feeding to be compiled by the SDO.
Keep columns 6-12 blank if nutritional assesment is still suspended.
SBFP Form 2 (2021)
Department of Education
Region CARAGA
SCHOOL-BASED FEEDING PROGRAM (SBFP) SUMMARY OF BENEFICIARIES & START OF FEEDING (SY 2022-2023)
Division/Province: AGUSAN DEL SUR
City/ Municipality/Barangay : ESPERANZA/ ANOLINGAN
Name of School / School District : ANOLINGAN IS/ ESPERANZA DISTRICT II
School ID Number: 501294
Date of Start of Feeding: OCTOBER 18, 2022
Last Mile School: N
Nutritional Status at Start/End of Feeding No. of Secondary Targets No. of 4 No. of 4 No. of Date Feeding
Learners Ps Pupils who Started/Ended
Number of No. of Dewormed Beneficiar are
Undernourished SW W N OW+O SS S N T No. of No. of No. of
Pupils-at- Stunted/ Indigent Indigenou ies beneficiarie
School Children by risk-of- Severely Learners s Peoples s in
Grade Level dropping- Stunted (IPs)
previous
out years
(PARDOs) (Repeaters)
1 2 21 0 0 5 19 0
1. Kinder 24 0 0 October 18, 2022
1 0 0 0 0 0 1 0
2. Grade I 1 0 0 October 18, 2022
1 0 0 0 0 1 0
3. Grade III 1 0 0 October 18, 2022
3 2 0 0 1 2 2 0
4. Grade IV 5 1 0 October 18, 2022
2 2 0 0 0 0 4 0
5. Grade V 4 2 1 October 18, 2022
1 0 0 1 0 0 0
6. Grade VI 1 0 1 October 18, 2022
Total 7 8 21 0 2 7 27 0 0 0 0 0 36 3 2
October 18, 2022
Prepared by: Approved by:
(COUNTER SIGN Nurse)
ROSE MAE C. PAWAY DULCE AMOR C. PAWAY
SBFP DepEd Focal School Head
Note: This form shall be prepared by the school before the start of feeding and after feeding, to be compiled by the SDO, and for final compilation by the RO, for
submission to DepEd BLSS-SHD
SBFP Form 3 (2021)
SCHOOL-BASED FEEDING PROGRAM
RECORD OF DAILY FEEDING
FOR THE MONTH OF OCTOBER , SY 2023-2024
Region ____________________________
Division ___________________________ School: _____________________________________
District ___________________________ School ID Number: _________________________
NAME OF PUPIL ACTUAL FEEDING
5 12
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15
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:
____________________________
B. Deworming D. Actual Feeding
Feeding Teacher / School Nurse
( x ) - not dewormed (N ) - Present, served with NFP
Approved by: ( √ ) - dewormed (M ) - Present, served with Milk
(N/M ) - Present, served with NFP & Milk
( A ) - Absent, not served
School Head (N2/M2/(N/M2)) - Present, served twice
Note: This form shall be prepared by the school to be consolidated using the Revised OKD Form A.
16 17 18 19 20
SBFP Form 3 (2021)
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
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:
page 2
D. Actual Feeding
(N ) - Present, served with NFP
(M ) - Present, served with Milk
(N/M ) - Present, served with NFP & Milk
( A ) - Absent, not served
(N2/M2/(N/M2)) - Present, served twice
page 2
53 54 55 56 57 58 59 60
page 2
SBFP Form 3 (2021)
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
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:
page 3
D. Actual Feeding
(N ) - Present, served with NFP
(M ) - Present, served with Milk
(N/M ) - Present, served with NFP & Milk
( A ) - Absent, not served
(N2/M2/(N/M2)) - Present, served twice
page 3
93 94 95 96 97 98 99 100
page 3
SBFP Form 3 (2021)
SCHOOL-BASED FEEDING PROGRAM
FOR THE MONTH OF ______________________ , SY _____________
Region ____________________________
Division ___________________________ School: _____________________________________
District ___________________________ Grade: __________ Section _____________________
School ID Number: _________________________
ACTUAL FEEDING
ATTENDANCE
NAME OF PUPIL No. of
Days
Present
101 102 103 104 105 106 107 108 109 110 111 112 113 114 115 116 117 118 119 120 (A)
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:
page 4
D. Actual Feeding
(N ) - Present, served with NFP
(M ) - Present, served with Milk
(N/M ) - Present, served with NFP & Milk
( A ) - Absent, not served
(N2/M2/(N/M2)) - Present, served twice
page 4
ATTENDANCE
No. of
Feeding Percentage
Days
(B) (A/B)*100
AVERAGE:
page 4
SBFP Form 4 (2021)
DEPARTMENT OF EDUCATION
Region CARAGA
REGION/DIVISION/DISTRICT: CARAGA/AGUSAN DEL SUR/ ESPERANZA II
NAME OF SCHOOL: ANOLINGAN IS
SCHOOL ID NO.: 501294
SCHOOL-BASED FEEDING PROGRAM - NFP/MILK
LIST OF AUTHORIZED CONSIGNEES (SY 2022-2023)
NAME & DESIGNATION TEL. NO. MOBILE NO. EMAIL ADD SPECIMEN
SIGNATURE
1 (School Head)
DULCE AMOR C. PAWAY NONE 9480423339
[email protected]
2 (School Feeding Coordinator)
ROSE MAE C. PAWAY NONE 9667633423
[email protected]
3 (School Property Custodian)
NONE 9476240941
VALENTINA N. BANATE [email protected]
SCHOOL INSPECTION TEAM (SY 2022-2023)
NAME & DESIGNATION TEL. NO. MOBILE NO. EMAIL ADD SPECIMEN
SIGNATURE
1 DULCE AMOR C. PAWAY
NONE 9480423339
[email protected]
2 ROSE MAE C. PAWAY
NONE 9667633423
[email protected]
3 VALENTINA N. BANATE
NONE 9476240941
[email protected]
Note: Only authorized consignees are allowed to receive the goods.
SBFP Form 5 (2021)
DEPARTMENT OF EDUCATION
Region CARAGA
REGION/DIVISION/DISTRICT: CARAGA/AGUSAN DEL SUR/ TALACOGON EAST
NAME OF SCHOOL: SAN ISIDRO ES
SCHOOL ID NO.: 212059
SCHOOL-BASED FEEDING PROGRAM - MILK COMPONENT
LIST OF BENEFICIARIES (SY 2022-2023)
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
1 IVAN CAMARINES Kinder - A /
2 DEGUINIO DANIEL Kinder - A /
3 ENGALAN LEO JAY Kinder - A /
4 MERCADO ANGELOU Kinder - A /
5 MERCADO LEO Kinder - A /
6 PEREZ JOHN CRIS Kinder - A /
7 RAMOS JAKE Kinder - A /
8 BORMUEL KYLIE MAE Kinder - A /
9 MERCADO NELIAN Kinder - A /
10 ENGALAN JEFRIL Grade 1 - Okra /
11 GONZALES CHRIST JOY Grade 1 - Okra /
12 GONZALES JERWIN Grade 1 - Okra /
13 GOYO FLORO Grade 1 - Okra /
14 MANLANGIT VENCENT Grade 1 - Okra /
15 MARIANITO VERNAN Grade 1 - Okra /
16 MARIENTES JOHN KYLLE Grade 1 - Okra /
17 ONEZ NINO Grade 1 - Okra /
18 OTAZA CHARLIE Grade 1 - Okra /
19 LACIA PRENCES CARLYN Grade 1 - Okra /
20 RIZAGA CHARLYN Grade 1 - Okra /
21 DAAS NELK CHRIST Grade 2 - Hope /
SBFP Form 5 (2021)
22 GOLORAN RICK JOHN Grade 2 - Hope /
23 LACIBAL MELBE Grade 2 - Hope /
24 RAMOS JESSEL MAY Grade 2 - Hope /
25 BARRIOS MARLON Grade 2 - Hope /
26 GOYO JOHN MIKE Grade 3 - Apple /
27 MERCADO RIAN Grade 3 - Apple /
28 MANLANGIT ELDRIAN Grade 4 - Gold /
29 MARIANITO SHELDON Grade 4 - Gold /
30 GOYO ANGELINE Grade 4 - Gold /
31 OTAZA CERELYN Grade 4 - Gold /
32 RAMOS JEIAN Grade 4 - Gold /
33 MERCADO JOYFUL Grade 4 - Gold /
34 MERCADO NEIL JUNE Grade 4 - Gold /
35 ONEZ DICKENS Grade 5 - Narra /
Prepared by: APPROVED BY:
MARIFE JOY ESCOZA THELMA P. CRUZ
School Feeding Coordinator School Head
SBFP Form 6 (2021)
DEPARTMENT OF EDUCATION
Region CARAGA
REGION/DIVISION/DISTRICT: CARAGA/AGUSAN DEL SUR/ TALACOGON EAST
NAME OF SCHOOL: SAN ISIDRO ES
SCHOOL ID NO.: 212059
SCHOOL-BASED FEEDING PROGRAM
NFP DELIVERIES (SY2021-2022)
Grade Level Number of Beneficiaries Date Delivered No. of Packs Received No. of Packs for
Replacement/
New Replacement Total (New + Rejected
Replacement)
Kinder 9 AUG. 28, 2023
Grade 1 11 Sep 10, 2023
Grade 2 5
Grade 3 2
Grade 4 7
Grade 5 1
Grade 6 0
TOTAL: 35
MILK DELIVERIES (SY 2021-2022)
Grade Level Number of Beneficiaries Date Delivered No. of Packs Received No. of Packs for
Replacement/
New Replacement Total (New + Rejected
Replacement)
Kinder 9 SEP. 5, 2023
Grade 1 11 Sep 10, 2023
Grade 2 5
Grade 3 2
Grade 4 7
Grade 5 1
Grade 6 0
TOTAL: 35
SBFP Form 6 (2021)
Prepared by: APPROVED BY:
MARIFE JOY ESCOZA THELMA P. CRUZ
School Feeding Coordinator School Head
SBFP Form 6 (2021)
Remarks
Remarks
