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2018-2019 PPAN Form 1

Department of Education
Region ___

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

Division/Province: __________________ ZAMBOANGA SIBUGAY Name of Principal : _ DENNIS M. YAPE


City/ Municipality/Barangay : __________ KABASALAN/SAYAO Name of Feeding Focal Person : EMMABEL M. OMEREZ
Name of School / School District : _____ SAYAO PS/KABASALAN DISTRICT

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

KINDER 1 DEGURO, JEZREL MANDANGAN M 7/2/2013 5/28/2018 14 1.01 NO JIMMY DEGURO/ MANNIELYN
MANDANGAN NO
KINDER 2 MIJARES, IVAN CARL M 4/13/2013 5/28/2018 5 16 1.04 14.70 Normal NO
LAVIE S. MIJARES/
LORDELIZA CAMBAL NO
KINDER 3 FRANCISCO, JESSICA F 6/27/2013 5/28/2018 15 1.11 NO RONALDO FFRANCISCO NO
KINDER 4 MAGHANOY, CRISTENE JOY F 12/28/2012 5/28/2018 5 16 1.12 12.70 Normal NO
MAGHANOY CANDIDO/
CRISTINA SAMPAYAN NO
KINDER 5 PALACIO, AGNES SAMPAYAN F 7/28/2013 5/28/2018 16 1.08 NO ARLENE PALACIO NO
KINDER 6 PARADO, CLARENCE KATE F 4/14/2013 5/28/2018 5 14 0.99 14.20 Normal NO PARADO, EDUARDO JR NO
KINDER 7 PARADO, MARDEL GRACE F 1/21/2013 5/28/2018 5 21 1.11 17.00 Normal NO JUNDEL MAR PARADO NO
KINDER 8 PEREZ, MARIANNE FAITH F 7/14/2012 5/28/2018 5 19 1.15 14.30 Normal YES PEREZ, MARK BRYAN NO
KINDER 9 SALUMBAO, LYCKA JANE TANDUS F 8/14/2013 5/28/2018 17 1.04 NO SALUMBAO, ROMEO NO
KINDER 10 TANDUS, RENELYN SANIEL F 1/6/2013 5/28/2018 5 15 1.04 13.80 Normal NO TANDUS, RENATO NO

Prepared by: Noted by:

EMMABEL M. OMEREZ DENNIS M. YAPE


Feeding Coordinator School Head

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
2018-2019 SBFP Form 1
Department of Education
Region ___

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

Division/Province: __________________ ZAMBOANGA SIBUGAY Name of Principal : _ DENNIS M. YAPE


City/ Municipality/Barangay : __________ KABASALAN/SAYAO Name of Feeding Focal Person : EMMABEL M. OMEREZ
Name of School / School District : _____ SAYAO PS/KABASALAN DISTRICT

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

1 1 BANAWA, ALFRED SANDALAN M 8/1/2011 5/28/2018 6 16 1.15 12.00 SU NO NOLLY BANAWA/ JULIET
SANDALAN NO
1 2 DEGURO, JERALD JHON SUMUSO M 7/24/2011 5/28/2018 6 16 1.19 11.20 SU NO GASPAR DEGURO/ JENILYN
SUMUSOG NO
1 3 LAGUMBAY, JIMBO DULUHAN M 4/12/2012 5/28/2018 6 12 1.04 11.00 SU NO JOSE LAGUMBAY/ JONAH
DULUHAN NO
2 4 SANDALAN, JULITO JR GREGANA M 12/3/2010 5/28/2018 7 15 1.07 13.1 U NO JULITO SANDALAN
SR./LUCENA GREGANA NO
2 5 TANDUS, NICOLE JADE MAGHANO M 4/24/2011 5/28/2018 7 15 1.09 12.6 U YES RONALD TANDUS/
CATHERINE MAGHANOY NO
2 6 DANDING, LENDSAY SANDALAN F 6/20/2011 5/28/2018 6 15 1.15 11.3 SU NO RONALD DANDING/ JUANITA
SANDALAN NO
3 7 DANDING, JOHN RICH SANDALAN M 3/5/2010 5/28/2018 8 17 1.15 12.8 U YES RONALD DANDING/ JUANITA
SANDALAN NO
3 8 PALACIO, AIRENE SAMPAYAN F 9/18/2010 5/28/2018 7 18 1.19 12.7 U NO TEODORICO SAMPAYAN/
ARLENE SAMPAYAN NO
4 9 CAWAN, MARLITO M 6/8/2009 5/28/2018 8 18 1.19 12.7 U YES MARLYN CAWAN NO
4 10 DEGURO, HAZEL MANDANGAN F 9/10/2009 5/28/2018 8 15 1.13 11.7 SU YES JIMMY DEGURO/ MANNIELYN
MANDANGAN YES
4 11 SANDALAN, LENY MONTER F 4/23/2009 5/28/2018 9 16 1.11 12.9 U YES LITO SANDALAN/ ALONA
MONTER NO
5 12 GALLEPOSO, MARVIN CAWAN M 3/25/2008 5/28/2018 10 21 1.26 13.2 U NO EDGARDO GALLEPOSO/
MERLITA CAWAN NO
5 13 GULO, ROLAND FRANCISCO M 1/15/2008 5/28/2018 10 23 1.32 13.2 U YES REYMOND GULO/ MELINDA
FERNANDO NO
5 14 DANDING, RONA JEAN SANDALAN F 9/23/2008 5/28/2018 9 20 1.25 12.8 U YES RONALD DANDING/ JUANITA
SANDALAN NO
5 15 GAUDIANO, KRISTEL JANE F 5/24/2008 5/28/2018 10 16 1.16 11.8 SU YES ROGER GAUDIANO/ ARSENIA
TANDUS YES
5 16 SANDALAN, MARICEL MONTER F 5/8/2008 5/28/2018 10 20 1.24 13 U YES LITO SANDALAN/ ALONA
MONTER NO
Prepared by: Noted by:
EMMABEL M. OMEREZ DENNIS M. YAPE
Feeding Coordinator School Head

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
PPAN Form 3 SY 2018-2019
Department of Education
Region _IX

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


Division/Province: ___________ ZAMBOANGA SIBUGAY
City/ Municipality/Barangay : __ SAYAO, KABASALAN
Name of School / School District SAYAO PS/ KABASALAN DISTRICT
Nutritional Status at Start of Feeding
Number of Undernourished School
Children by Grade Level No. of No. of Pupils who
Severely No. of Total are beneficiaries in
Wasted Wasted Beneficiaries No. of 4 Ps Beneficiaries previous years Remarks

1. Kinder 0 0 10 1 0

2. Grade I

3. Grade II

4. Grade III

5. Grade IV

6. Grade V

7. Grade VI

Total 0 0 10 1 0

Prepared by: Noted by:

EMMABEL M. OMEREZ DENNIS M. YAPE


Feeding Coordinator School Head

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
PPAN Form 3 SY 2018-2019
Department of Education
Region _IX

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


Division/Province: ___________ ZAMBOANGA SIBUGAY
City/ Municipality/Barangay : __ SAYAO, KABASALAN
Name of School / School District SAYAO PS/ KABASALAN DISTRICT
Nutritional Status at Start of Feeding
Number of Undernourished School
Children by Grade Level No. of No. of Pupils who
Severely No. of Total are beneficiaries in
Wasted Wasted Beneficiaries No. of 4 Ps Beneficiaries previous years Remarks

1. Kinder 0 0 0 0 0

2. Grade I 3 0 3 0 0

3. Grade II 1 2 3 1 0

4. Grade III 0 2 2 1 0

5. Grade IV 1 2 3 3 1 Lack of appetite in eating

6. Grade V 1 4 5 4 1 Lack of appetite in eating

7. Grade VI 0 0 0 0 0

Total 6 10 16 9 2

Prepared by: Noted by:

EMMABEL M. OMEREZ DENNIS M. YAPE


Feeding Coordinator School Head

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 SY 2017-2018
Department of Education
Region ___

SCHOOL-BASED FEEDING PROGRAM (SBFP) LIST OF SCHOOLS

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:

__________________________
NURSE II Public Schools District Supervisor
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
SY 2017-2018
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 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 9
Note: This form shall be prepared by the school to be consolidated using SBFP Form 5

Page 10
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
101 102 103 104 105 106 107 108 109 ### 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:
Prepared by: Noted by:
_________________
Feeding Coordinator ____________________
D. Actual Feeding
School Head
( √ ) - Present, served
( A ) - Absent, not served
(√√ ) - Present, served twice

page 4
page 4
SBFP Form 5
SCHOOL-BASED FEEDING PROGRAM

CONSOLIDATED NUTRITIONAL STATUS AND ATTENDANCE REPORT


Region: _______
Division/District: ________________________
School: ________________________________
BEIS ID No.: ___________________________
NUTRITIONAL STATUS
No. of Pupils BEFORE AFTER PERCENTAGE
GRADES AND SECTIONS
Dewormed ATTENDANCE
SW/SU W/U N Ow Ob Total SW/SU W/U N Ow O Total
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
TOTAL 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:
_____________________________ ___________________________
Classroom Adviser / School Nurse School Head

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