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8/15/2019 2. SBFP Forms June 2015-2016 Baseline Report
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SBFP Form 1
Department of Education
Region I
Master List Benefciaries or School-Based Feeding Program (SBFP)
No. Name Sex Nutritional Status (NS) Ethnicit
1 Aquino, Tyron M. M 6/7/2010 6/16/2015 60 mos 13 1.05 Underweight Pngsinense
2 Mn#o, Mry##ee &. M 1/13/2010 6/16/2015 65 mos 1' 0.(6 Underweight Pngsinense3 Mnois , -#erino . M 2/5/2010 6/16/2015 6' mos 1' 1.0 Underweight Pngsinense
4 Mi#o, Aron M*y +. M 1/2'/2010 6/16/2015 6' mos 13 1.05 eere#y Underweight Pngsinense
5 -i##nue, A#e4nder . M 6/16/2015 6,6 16 1.12 sted Pngsinense
6 8orond, :me*h :smin 8 (/5/2010 6/16/2015 57 mos 12 1.02 Underweight Pngsinense
7 +enero, :smine . 8 (/22/2010 6/16/2015 56 mos 13 1.02 Underweight Pngsinense
8 Prs, Andre ;orreine
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27 ;ndingin in $ose 8 6/16/2015 55 mos 13 0 ( Underweight Pngsinense
No. Name Sex Nutritional Status (NS) Ethnicit!ate o Birth(MM"!!"###
#)
!ate o$eighing "Measuring
(MM"!!"#### )
%ge in #ears "Months
$eight(&g)
'eight(cm)
BM or .o. anda*o+e
!isa*ilit
,Ps !Num*er
34 &gy, =ristine +. 8 6/16/2015 56 mos 13 1 Underweight Pngsinense
35 +)rie#, Mri 8 (/21/2010 6/16/2015 56 mos 13 1 Underweight Pngsinense
36 :imene9, :smine 8 5/25/2010 6/16/2015 60 mos 13 1.02 Underweight Pngsinense
37 Mm, Prin*ess r# &. 8 6/16/2015 55 mos 11 0.(' eere#y Underweight Pngsinense
38 %rg, M. :enni* $. 8 5/2/2010 6/16/2015 60 mos 11 1 eere#y Underweight Pngsinense
39 >)#, Mrin rish 8 5/2'/2010 6/16/2015 60 mos 12 1.02 eere#y Underweight Pngsinense
40 o##do, :yden Brey !. M (/7/200( 6/15/2015 6(mos. 15 1.06 sted Pngsinense
41 +##rdo, e4hin Mtthew M 6/15/2015 67 mos. 15 1.02 sted Pngsinense
42 Mores, :hs?er ;mod M 3/11/200( 6/15/2015 15 1.13 eere#y Underweight Pngsinense
43 A#on, :i#in &om)i## 8 6/15/2015 66 mos. 1' 1.05 sted Pngsinense
44 ioquino, :smine Andre M. 8 7/7/200( 6/15/2015 71 mos. 15 1.17 sted Pngsinense
45 &ernrde9 :r., . M 2/(/200 6/15/2015 7,' 15 1.0( 12.6 sted Pngsinense
56 Prs, %oh ;. M 3/17/200( 6/15/2015 6,2 15 1.1 12.3 sted Pngsinense
57 Prs, $ino 8. M 1/(/200 6/16/2015 7,5 1( 1.2 13.1 sted Pngsinense
58 Prsmo, Mr Aien M (/(/200 6/15/2015 6,( 15 1.13 11.7 eere#y Underweight Pngsinense
59 errno, =en ;ouise ;. M 6/15/2015 67 mos. 15 1.0 sted Pngsinense
60 8errer, >yrene A. 8 /5/200( 6/15/2015 70 mos. 1' 1.02 sted Pngsinense
61 >)#, $hinne 8 (/10/200( 6/15/2015 6( mos. 1' 0.(6 sted Pngsinense
62 A#monte, A#wyne $. M 5/21/200 6/1(/2015 7,0 17 1.16 12.6 sted Pngsinense
63 m*ho,
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No. Name Sex Nutritional Status (NS) Ethnicit!ate o Birth(MM"!!"###
#)
!ate o$eighing "Measuring
(MM"!!"#### )
%ge in #ears "Months
$eight(&g)
'eight(cm)
BM or .o. anda*o+e
!isa*ilit
,Ps !Num*er
74 8errer, Prin*ess A. 8 6/17/2015 7,6 1 1.2 12.5 sted Pngsinense
75 +s?r, :mi# $. 8 //200 6/17/2015 6,10 1 1.21 12.2 sted Pngsinense
76 8or*, A#e4nder Me#in M 6/16/2015 7,6 1 1.17 13.1 sted Pngsinense
77 o#ori*o, $egie#s . 8 2/3/200 6/16/2015 7,' 16 1.16 11. sted Pngsinense 35612537
78 ;u*erin, rmin %. 8 3/7/200 6/16/2015 7,3 1 1.1( 12.7 sted Pngsinense
79 )##ero, hristin &. M 7/1'/2007 6/17/2015 7,11 16 1.11 12.( sted Pngsinense
80 Mrgn, Ange#o
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No. Name Sex Nutritional Status (NS) Ethnicit!ate o Birth(MM"!!"###
#)
!ate o$eighing "Measuring
(MM"!!"#### )
%ge in #ears "Months
$eight(&g)
'eight(cm)
BM or .o. anda*o+e
!isa*ilit
,Ps !Num*er
114 Prs, Mi 8tim &. 8 6/16/2015 (,7 22 1.3 13 sted Pngsinense 35301307
115 Trinidd, hr#ene :oy 8 6/16/2015 (,7 21 1.2 12. sted Pngsinense
116 -id#, $i* Me . 8 6/16/2015 11,5 2' 1.31 13.( sted Pngsinense 3530'157117 o#oque,
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SBFP Form Department of Education
Region I
S'L-B%SE! FEE!N/ P0/0%M (SBFP)
tritional Status at Start o Feedi Ethnicit , Ps Benefciaries
o. o Ethnic Be o. o , Ps Ben 0emar1s
1. in+er 13 26 39 0 6 0
. Gra+e I 5 17 22 0 1 1
0. Gra+e II 2 16 18 0 3 2
. Gra+e III 4 3 7 0 2 1
2. Gra+e I3 2 12 14 0 3 1
4. Gra+e 3 3 19 22 0 6 2
5. Gra+e 3I 3 11 14 0 3 1
2otal 34 56, 53 6 4, 7
!repared ,&" #oted ,&"
L!E"# G. C#LM# M#!G$% B. C#L&L&$' Ph.D.*()! DepEd )oca$ /nit %+ief
Division!rovince" Dagupan City / Pangasinan
%it& 'unicipa$it&(aranga& " Dagupan City / Bonuan Gueset#ame of *c+oo$ *c+oo$ District " General Gregorio Del Pilar Elementary School / District III
Num*er o 8ndernourishedSchool hildren * /rade
Le+el
No. oSe+erel$asted
No. o$asted
2otalBenefciari
es
*enefciariesin 9re+ious
ears
"ote( $his )orm shall *e prepare+ *y the school' to *e compile+ *y the D' an+ )or )inal compilation *y the !' )or su*mission to DS,D-F' copy )urnishe+ DepE+-%"C
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SBFP Form 0Department of Education
Region
S'L-B%SE! FEE!N/ P0/0%M (SBFP)
Division!rovince"
*c+oo$ District%it& 'unicipa$it& "
Name o Schools BES ! No. School %ddress me o Barang ontact Num*er
!repared ,&" #oted ,&"
*()! DepED )oca$ /nit %+ief
Name o !istrictSu9er+isors"
School Princi9alor s
2otalBenefciari
es
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"ote( $his )orm shall *e prepare+ *y the D' )or )inal consoli+ation *y the !' )or su*mission to DS,D-F' copy )urnishe+ DepE+-%"C
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SBFP Form
SC%L-B#SED FEEDI"G P!G!#M
Gra+e( 6666666666 Section 666666666666666666666
"#ME F P&PIL
P!E FEEDI"G#C$L FEEDI"G
ge
(irt+ Date
*e#utritiona$ *tatus Deorming
23 24 25 26 29 30 1 2 3 7 8 9 10 13 14 15 16a e#*
a e
cm g aen aen 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 171 Arenas, Jeayea P. 53 mos 1032009 ) 095 11 6112014 */2 Sembrana, Honey Khae 61 mos 562009 ) 102 11 6112014 */3 Paras, Noah 65 mos 12122008 ' 103 12 6112014 */4 Reyes, Dexter 64 mos 1282009 ' 105 12 6112014 */5 Bernardez Jr. Eduardo M. 66 mos 11162008 ' 1 13 6112014 */6 De Guzman, Me!"n P. 61 mos 4212009 ' 108 12 6112014 */ 7 Doo#ue, John Patr"$% 63 mos 2132009 ' 106 11 6112014 */8 &ae'a, San Joe E. 61 mos 522009 ' 104 14 6112014 /9 Pan(an"ban, Aexander James S. 62 mos 3262009 ' 099 12 6112014 */
10 De Guzman, Mar% ). 60 mos 5182009 ' 096 13 6112014 /11 )"da, Anthonette Ge D&. 66 mos 11252008 ) 11 14 6112014 /
12 )eoso, G"z P. 68 mos 9202008 ) 096 13 662014 *13 &au*"t, Ashey 66 11112007 ) 107 17 662014 *14 Abue, Rhen$e +. 69 mos 8282008 ) 106 13 662014 *15 &a*"n*"n, Pr"n$ess Mae P. 71 mos 6122008 ) 098 11 662014 *16 Nara(, Jasm"n 71 mos 692008 ) 103 13 662014 *17 Munar, Shanee r"sh &. 74 1232007 ) 115 17 692014 *18 Mara(ana, An(eo E. 97 10162004 ' 128 19 692014 *19 Dea &ruz, Jessayn Joy +. 1110 862002 ) 198 40 692014 *20 -ao, Jerome ). 84 1172006 ' 114 17 692014
21 Mer$ado, Edra Jane : 87 10272005 ) 116 17 692014 22 Samson, Ju!eyn S. : 711 6122006 ) 132 20 692014 *23 A#u"no, Mar$"o S. : : 106 11282003 ' 118 17 692014 *24 )"da, E"zabeth . 80 5152006 ) 12 18 692014 25 Ar(uees, John /ayne &. : 78 9202006 ' 121 19 692014 26 Reyes, Kassandra Kye 99 982004 ) 136 22 6102014 *27 Am*aayan, Adr"n M. 96 1272004 ' 13 19 6102014 *28 0oraba, Jesus Gabr"ee &. 92 3242005 ' 135 22 6102014 *29 Paras, &ar"ssa S. 910 7262004 ) 132 21 6102014 *
30 &arrera, &"ndy 126 11212001 ) 145 25 6102014 *31 &orb"on, &hr"st"an . : 123 2262002 ' 137 25 662014 *32 +azo, Ru1e" J. : 115 162003 ' 126 20 662014 *33 )eoso, Remed"os P. 110 662003 ) 145 25 662014 *34 Gut"errez, /"2red S. 112 3292003 ' 121 19 662014 *35 Gar$"a Paua ) 10 5 12282003 ) 1 24 19 662014 *
F! $%E M"$% F SEP$EMBE!/C$BE! ' S.7. 81!egion( IDi9ision( Dagupan City School( GE"E!#L G!EG!I DEL PIL#! ELEME"$
District( III
4!s(eneficiar&;& orn<
(eneficiar& of
!revious*()!
;& or n<;= < or
;><
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SBFP Form
SC%L-B#SED FEEDI"G P!G!#M
Gra+e( 6666666666 Section 666666666666666666666
"#ME F P&PIL
P!E FEEDI"G#C$L FEEDI"G
ge
(irt+ Date
*e#utritiona$ *tatus Deorming
23 24 25 26 29 30 1 2 3 7 8 9 10 13 14 15 16t t Date#*
Date
cm g aen aen 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17
F! $%E M"$% F SEP$EMBE!/C$BE! ' S.7. 81!egion( IDi9ision( Dagupan City School( GE"E!#L G!EG!I DEL PIL#! ELEME"$#
District( III
4!s(eneficiar&;& orn<
(eneficiar& of
!revious*()!
;& or n<;= < or
;><
37 )"da, An(e"$a 117 10222002 ) 136 24 6102014 *38 &abaar, &aros Jone ). 120 622002 ' 142 24 692014 *39 0amayo, Maron D. : 145 12221999 ' 15 31 692014 *
40 A#u"no, Ben'"e ). : : 146 11141999 ' 142 30 692014
$$#L(Prepared by:
L E G E " DL!E"# G. C#LM# #. "utritional Status
B. De:orming D. #ctual Fee+ing)eeding eac+er *c+oo$ #urse For 4-1; y.o For *elo: 4 y.o
"ote( $his )orm shall *e prepare+ *y the school to *e consoli+ate+ using SBFP Form 2
S, . *evere$& asted S& . *evere$& undereig+t ; < < . not deormed ; = < . !resent served
, . asted & . /ndereig+t ; = < . deormed ; # < . ,sent not served
" . #orma$ " . #orma$ ;== < . !resent served tice
: . -verieg+t : . -verieg+t
. -,ese
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SBFP Form
SC%L-B#SED FEEDI"G P!G!#M
F! $%E M"$% F C$BE! / "3EMBE! / DECEMBE! ' S7 81-812
Gra+e( 6666666666 Section 666666666666666666666
"#ME F P&PIL
#C$L FEEDI"G
22 23 27 28 29 30 31 3 4 5 6 7 10 11 12 14 17 18 19 20 21 24 25 26 27 28 1 2 3 4 5 8 9 10 11 12 1521 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 43 44 45 46 47 48 49 50 51 52 53 54 55 56 57
1 renas ?ea&ea !2 *em,rana one& @+ae
3 !aras #oa+4 Re&es Deter 5 (ernardeA ?r Eduardo '6 De BuAman 'e$vin !7 Do$oCue ?o+n !atric8 %a$$ea *an ?oe E9 !angani,an $eander ?ames *
10 De BuAman 'ar 11 ida$ nt+onette Be$ D%
12 e$oso BiA$ !13 %a$upit s+$e&14 ,u$e R+ence$ F15 %apinpin !rincess 'ae !16 #arag ?asmin
17 'unar *+ane$$e Iris+ %18 'aragana nge$o E19 De$a %ruA ?essa$&n ?o& F20 :ao ?erome 21 'ercado Edra ?ane
22 *amson ?uve$&n *23 Cuino 'arci$o *24 ida$ E$iAa,et+ )25 rgue$$es ?o+n a&ne %26 Re&es @assandra @&$e27 mpa$a&an $drin '28 ora$,a ?esus Ba,rie$$e %29 !aras %$arissa *30 %arrera %ind&
31 %or,i$$on %+ristian )32 FaAo Ruei ?33 e$oso Remedios !
34 ButierreA i$fred *35 Barcia !au$a 36 Fa,rador #ormie Fea !
!egion IDi9ision Dagupan City School( GE"E!#L G!EG!I DEL PIL#! ELEME"$#!7 SC%L
District III
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SBFP Form
SC%L-B#SED FEEDI"G P!G!#M
F! $%E M"$% F C$BE! / "3EMBE! / DECEMBE! ' S7 81-812
Gra+e( 6666666666 Section 666666666666666666666
"#ME F P&PIL
#C$L FEEDI"G
22 23 27 28 29 30 31 3 4 5 6 7 10 11 12 14 17 18 19 20 21 24 25 26 27 28 1 2 3 4 5 8 9 10 11 12 1521 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
!egion IDi9ision Dagupan City School( GE"E!#L G!EG!I DEL PIL#! ELEME"$#!7 SC%L
District III
37 ida$ nge$ica38 %a,a$ar %ar$os ?one$ 39 ama&o 'ar$on D
40 Cuino (enie
$$#L
D. #ctual Fee+ing
; = < . !resent served
; # < . ,sent not served
;== < . !resent served tice
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SBFP Form
SC%L-B#SED FEEDI"G P!G!#M
F! $%E M"$% F 6666666666666666666666 ' S7 81-812!egion IDi9ision Dagupan City School( GE"E!#L G!EG!I DEL PIL#! ELEME"$#!7 SC%L
District III Gra+e( 6666666666 Section 666666666666666666666
"#ME F P&PIL
#C$L FEEDI"G
58 59 60 61 62 63 64 65 66 67 68 69 70 71 72 73 74 75 76 77 78 79 80 81 82 83 84 85 86 87 88 89 90 91 921 renas ?ea&ea !2 *em,rana one& @+ae
3 !aras #oa+4 Re&es Deter 5 (ernardeA ?r Eduardo '6 De BuAman 'e$vin !7 Do$oCue ?o+n !atric8 %a$$ea *an ?oe E9 !angani,an $eander ?ames *
10 De BuAman 'ar 11 ida$ nt+onette Be$ D%
12 e$oso BiA$ !13 %a$upit s+$e&14 ,u$e R+ence$ F15 %apinpin !rincess 'ae !16 #arag ?asmin
17 'unar *+ane$$e Iris+ %18 'aragana nge$o E19 De$a %ruA ?essa$&n ?o& F20 :ao ?erome 21 'ercado Edra ?ane
22 *amson ?uve$&n *23 Cuino 'arci$o *24 ida$ E$iAa,et+ )25 rgue$$es ?o+n a&ne %26 Re&es @assandra @&$e27 mpa$a&an $drin '28 ora$,a ?esus Ba,rie$$e %29 !aras %$arissa *30 %arrera %ind&
31 %or,i$$on %+ristian )32 FaAo Ruei ?33 e$oso Remedios !
34 ButierreA i$fred *35 Barcia !au$a 36 Fa,rador #ormie Fea !
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SBFP Form
SC%L-B#SED FEEDI"G P!G!#M
F! $%E M"$% F 6666666666666666666666 ' S7 81-812!egion IDi9ision Dagupan City School( GE"E!#L G!EG!I DEL PIL#! ELEME"$#!7 SC%L
District III Gra+e( 6666666666 Section 666666666666666666666
"#ME F P&PIL
#C$L FEEDI"G
58 59 60 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 9
37 ida$ nge$ica38 %a,a$ar %ar$os ?one$ 39 ama&o 'ar$on D
40 Cuino (enie
$$#L(
D. #ctual Fee+ing
; = < . !resent served
; # < . ,sent not served
;== < . !resent served tice
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SBFP Form
SC%L-B#SED FEEDI"G P!G!#M
F! $%E M"$% F 6666666666666666666666 ' S7 6666666666666!egion 6666666666666666666666666666
Di9ision 666666666666666666666666666 School( 6666666666666666666666666666666666666District 666666666666666666666666666 Gra+e( 6666666666 Section 666666666666666666666
"#ME F P&PIL
#C$L FEEDI"G PS$ FEEDI"G
#utritiona$ *tatust t Date
98 99 100 101 102 103 104 105 106 107 108 109 110 111 112 113 114 115 116 117 118 119 120 cm g aen #*
1 renas ?ea&ea !2 *em,rana one& @+ae3 !aras #oa+
4 Re&es Deter 5 (ernardeA ?r Eduardo '
6 De BuAman 'e$vin !7 Do$oCue ?o+n !atric
8 %a$$ea *an ?oe E9 !angani,an $eander ?ames *
10 De BuAman 'ar 11 ida$ nt+onette Be$ D%
12 e$oso BiA$ !
13 %a$upit s+$e&
14 ,u$e R+ence$ F15 %apinpin !rincess 'ae !
16 #arag ?asmin17 'unar *+ane$$e Iris+ %
18 'aragana nge$o E
19 De$a %ruA ?essa$&n ?o& F
20 :ao ?erome 21 'ercado Edra ?ane
22 *amson ?uve$&n *23 Cuino 'arci$o *
24 ida$ E$iAa,et+ )
25 rgue$$es ?o+n a&ne %26 Re&es @assandra @&$e
27 mpa$a&an $drin '28 ora$,a ?esus Ba,rie$$e %
29 !aras %$arissa *30 %arrera %ind&
31 %or,i$$on %+ristian )32 FaAo Ruei ?
33 e$oso Remedios !34 ButierreA i$fred *
!
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SBFP Form
SC%L-B#SED FEEDI"G P!G!#M
F! $%E M"$% F 6666666666666666666666 ' S7 6666666666666!egion 6666666666666666666666666666Di9ision 666666666666666666666666666 School( 6666666666666666666666666666666666666
District 666666666666666666666666666 Gra+e( 6666666666 Section 666666666666666666666
"#ME F P&PIL
#C$L FEEDI"G PS$ FEEDI"G
#utritiona$ *tatust t Date
98 99 100 101 102 103 104 105 106 107 108 109 110 111 112 113 114 115 116 117 118 119 120 cm g aen #*
35 Barcia !au$a 36 Fa,rador #ormie Fea !37 ida$ nge$ica
38 %a,a$ar %ar$os ?one$ 39 ama&o 'ar$on D
40 Cuino (enie
$$#L(
D. #ctual Fee+ing
; = < . !resent served
; # < . ,sent not served
;== < . !resent served tice
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CE
!ercentage
;(
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CE
!ercentage
;(
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SBFP Form 2
SC%L-B#SED FEEDI"G P!G!#M
C"SLID#$ED "&$!I$I"#L S$#$&S #"D #$$E"D#"CE !EP!$
Region"
DivisionDistrict" *c+oo$" (EI* ID #o"
BRDE* #D *E%I-#*
"&$!I$I"#L S$#$&S
BEF!E #F$E!
**/ / # - -, ota$ **/ / # - - ota$123456789
1011121314151617181920
-F #3E!#GE(Fegend"
For 6-19 y.o For below 6 y.o
!repared ,&" #oted ,&" %$assroom dviser *c+oo$ #urse *c+oo$ ead
"ote( $his )orm shall *e prepare+ *y the school using the +ata )rom SBFP Form .
#o of !upi$sDeormed
PE!CE"$#GE#$$E"D#"CE
S, . *evere$& asted S& . *evere$& /ndere g
, . asted & . /ndereig+t" . #orma$ " . #orma$: . -vereig+t : . -vereig+t . -,ese