SBFP Form 1 (2021)

Department of Education
Region IX

Master List Beneficiaries for School-Based Feeding Program (SBFP) (SY 2023-2024)

Division/Province: ZAMBOANGA DEL NORTE Name of Principal : ARIEL B. CRAMPATANTA EdD

City/ Municipality/Barangay : SINDANGAN, POBLACION Name of Feeding Focal Person : MINDALYN M. ARIP
Name of School / School District : SINDANGAN SPED CENTER/SINDNAGAN CENTRAL
School ID Number: 195535

Nutritional Parent's
Participation Beneficiary of
Grade/ Date of Weighing / Age in BMI for 6 Dewormed consent for
No. Name Sex Date of Birth Measuring Years /
Weight Height
y.o. and Status (NS) ? milk?
in 4Ps SBFP in
Section (MM/DD/YYYY)
(MM/DD/YYYY) Months
(Kg) (cm)
above (yes or no) (yes or
(yes or Previous Years
no) (yes or no)
no)
BMI-A HFA
1 Chandrey B. Edong M K 5/5/2018 9/29/2023 5.02 12 103 9.9 SW NO

2 Prinz Seth Grethan P. Fabra M K 2/15/2018 9/29/2023 5.05 15 100 10.4 SW NO

3 Ethan Aziel Falcarsantos M K 10/21/2017 9/29/2023 5.09 18 121 12.3

S NO

4 Rbien Yhalmerrz Gimena M K 10/1/2018 9/29/2023 5.02 13 112 12

SW NO

5 Mc Gabriel T. Padilla M K 3/22/2018 9/29/2023 5.04 11 109 12.3

SW NO

6 Thaleah Cayleihn Billones F K 7/8/2018 9/29/2023 5.06 15 100 15

SW NO

7 Mary Chexter Carlisle Garcia F K 10/15/2018 9/29/2023 5.02 17 100 13.2

S NO

8 Diana B. Lobiano F K 7/20/2018 9/29/2023 5.09 13 110 10.7 SW NO

9 Abigail Kate Manogura F K 7/3/2018 9/29/2023 5.01 12 110 12.3

SW NO

10 Athaliah Mendez F K 7/30/2018 9/29/2023 5.02 11 120 13.8 SW NO

11 Angelic Faye P. Nazer F K 1/17/2018 9/29/2023 5.01 18 100 13.2 S NO
12 Khassandra L. Patria F K 8/21/2018 9/29/2023 5.03 15 103 12.5 SW NO
13 Alleya A. Rabeza F K 9/28/2018 9/29/2023 5.06 12 112 9.8 SW NO
14 Leica Angeleia Rasonable F K 9/30/2018 9/29/2023 5.05 11 111 12.7 SW NO
15 Brianna Zia Ricablanca F K 9/28/2018 9/29/2023 5.11 13 111 11.9 SW NO
16 Sairah Jade I. Roleda F K 3/1/2018 9/29/2023 5.06 13 115 10.2 SW YES
17 Benhor F. Baya M 1 4/12/2017 9/29/2023 5.06 15 122 9.9 SW NO
18 Paul Dexter Garcia M 1 10/18/2017 9/29/2023 5.11 14 112 11.4 SW YES
19 Thaian Gave Villanueva M 1 8/1/2017 9/29/2023 6.01 16 111 13.9 S NO
20 Princess Yuanne D. De Guzman F 1 6/12/2017 9/29/2023 6.03 16 113 14.6 S NO
21 Trixhe T. Cabalida F 1 7/16/2017 9/29/2023 6.02 18 100 14.2 S NO
22 Alleysha M. Camasora F 1 7/22/2017 9/29/2023 6.02 17 105 14.3 S NO
23 April Ina Canton F 1 7/22/2017 9/29/2023 6.02 15 110 12.3 SW NO
24 Xhyra Glane Gabales F 1 7/6/2017 9/29/2023 6.02 17 108 14.5 S YES
25 Ellery Neveah Laurea F 1 7/7/2017 9/29/2023 6.02 18 105 14.2 S YES
26 Jewel S. Nemenzo F 1 7/11/2017 9/29/2023 6.02 17 116 14.8 S NO
27 Christ Niña Vergara F 1 11/24/2016 9/29/2023 6.1 17 114 13.5 S NO
28 Richelle Mae Ugdamina F 2 12/19/2016 9/29/2023 6.09 18 119 13.8 S NO
29 Ash Heddriel Caste M 2 12/27/2016 9/29/2023 6.09 16 121 14.1 S NO
30 Arianne Gimena F 2 11/20/2014 9/29/2023 6.1 18 116 14.8 S NO
31 Leigh Angela Rasonable F 3 6/5/2016 9/29/2023 7.3 16 121 11.9 SW NO
32 Albert Cian Talledo M 3 7/10/2012 9/29/2023 11.02 21 125 13.8 S NO
33 Isara Amray Espinas F 3 6/26/2013 9/29/2023 10.03 24 109 12.3 S NO
34 Aleah Bridgette Gadgode F 3 10/20/2013 9/29/2023 9.11 25 122 14.1 S NO
35 Mae Amor Gorre F 4 10/20/2012 9/29/2023 10.11 23 125 13.9 S NO
36 Christian John Alcopra M 4 12/22/2011 9/29/2023 11.11 24 124 13.2 S NO
37 Rachelle Ann Arcadio F 5 3/4/2012 9/29/2023 10.05 24 128 13.7 S NO
38 Alleah Dhynah Espina F 5 4/16/2012 9/29/2023 10.04 25 120 13.2 S NO
39 Julius Lomo M 5 9/18/2017 9/29/2023 6 16 115 14.1 S NO
40 Jhon Llorenz Sumalpong M 5 2/2/2011 9/29/2023 12.07 24 122 12.8 SW NO
41 Rafael English M 6 9/18/2017 9/29/2023 6 17 108 11.4 SW NO
42 Nathaniel Enoy M 6 8/15/2015 9/29/2023 8.01 20 124 13.1 S NO
43 Eugenio Ferolino Jr. M 6 10/13/2010 9/29/2023 12.11 23 113 14.2 S YES
44 Edriane Gonzales M NG 8/10/2009 9/29/2023 13.01 28 178 13.9 S NO
45 Jhon Leo Perater M NG 12/8/2015 9/29/2023 7.08 23 134 13.5 S NO
46 Zion Lee Wabe M NG 10/13/2017 9/29/2023 5.11 13 115 10.6 SW YES
47 Khier Malajay M NG 9/23/2017 9/29/2023 6 13 137 10.3 SW NO
48 Gen Archilles Arcadio M NG 5/31/2016 9/29/2023 7.04 15 1.29 11.2 SW NO
49 Felicity Grey Elopre F NG 6/23/2017 9/29/2023 6.03 20 1.6 14.1 S YES
50 Princess Suishene Ricafranca F NG 4/21/2015 9/29/2023 8.05 28 1.34 13.9 S NO
51 Miya Iyana Deniega F NG 6/5/2014 9/29/2023 9.03 25 1.61 12.8 S YES
52 Merah Thea Ibrahim F NG 11/20/2013 9/29/2023 9.1 26 1.41 12.3 S NO
53 Levien Polles F NG 3/26/2018 9/29/2023 5.05 11 100 9.6 SW YES
54 Princess Mae Polles F NG 2/28/2013 9/29/2023 10.07 15 105 10.2 SW YES
55 Myka Labajo F NG 7/6/2013 9/29/2023 10.02 16 114 10.6 SW YES
56 Marilyn Meñoza F NG 1/30/2012 9/29/2023 11.08 28 125 13.8 S YES

Prepared by:

Approved by:
MINDALYN M. ARIP
SBFP Deped Focal
ARIEL B. CRAMPATANTA EdD
School Principal III
SBFP Form 2 (2021)
Region IX

SCHOOL-BASED FEEDING PROGRAM (SBFP) SUMMARY OF BENEFICIARIES & START OF FEEDING (SY 2020-2021)
Division/Province: ZAMBOANGA DEL NORTE
City/ Municipality/Barangay : POBLACION, SINDANGAN
Name of School / School District : SINDANGAN SPECIAL EDUCATION CENTER
School ID Number: 195536
Date of Start of Feeding: SEPTEMBER 18, 2023
Last Mile School: ___Y _/_N
Nutritional Status at Start/End of Feeding No. of Secondary Targets No. of 4 No. of 4 Ps No. of Pupils Date Feeding
Learners Beneficiaries who are Started/Ended
Number of Undernourished SW W N OW+O SS S N T No. of No. of No. of No. of Dewormed beneficiaries
School Children by Grade Pupils-at- Stunted/ Indigent Indigenous in previous
risk-of- years
Level Severely Learners Peoples (Repeaters)
dropping- Stunted (IPs)
out
(PARDOs)
1. Kinder 13 3 0 0 2 2 9 0 0 0 9/18/2023

2. Grade I 6 5 0 0 6 5 0 0 0 0 9/18/2023
3. Grade II 0 3 0 0 0 3 0 0 0 0 9/18/2023

4. Grade III 0 4 0 0 0 4 0 0 0 0 9/18/2023

5. Grade IV 0 2 0 0 0 2 0 0 0 0 9/18/2023
6. Grade V 0 4 0 0 0 4 0 0 0 0 9/18/2023
7. Grade VI 1 2 0 0 1 2 0 0 0 0 9/18/2023
8. None Graded 5 8 0 0 5 8 0 0 0 6 9/18/2023
Total 25 31 0 0 25 31 0 0 0 6

Prepared by: Approved by:

MINDALYN M. ARIP ARIEL B. CRAMPATANTA EdD

SBFP DepEd Focal Principal III

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 ______________________ , SY _____________

Region: IX
Division: ZAMBOANGA DEL NORTE School: SINDANGAN SPED CENTER
District: SINDANGAN CENTRAL Grade: KINDER Section: KIND
School ID Number: 195535
ACTUAL FEEDING

NAME OF PUPIL

1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20
1 Chandrey B. Edong ̸̸
2 Prinz Seth Grethan P. Fabra
3 Ethan Aziel Falcarsantos
4 Rbien Yhalmerrz Gimena
5 Mc Gabriel T. Padilla
6 Thaleah Cayleihn Billones
7 Mary Chexter Carlisle Garcia
8 Diana B. Lobiano
9 Abigail Kate Manogura
10 Athaliah Mendez
11 Angelic Faye P. Nazer
12 Khassandra L. Patria
13 Alleya A. Rabeza
14 Leica Angeleia Rasonable
15 Brianna Zia Ricablanca
16 Sairah Jade I. Roleda
17 Benhor F. Baya
18 Paul Dexter Garcia
19 Thaian Gave Villanueva
20 Princess Yuanne D. De Guzman
21 Trixhe T. Cabalida
22 Alleysha M. Camasora
23 April Ina Canton
24 Xhyra Glane Gabales
25 Ellery Neveah Laurea
26 Jewel S. Nemenzo
27 Christ Niña Vergara
28 Richelle Mae Ugdamina
29 Ash Heddriel Caste
30 Arianne Gimena
31 Leigh Angela Rasonable
32 Albert Cian Talledo
33 Isara Amray Espinas
34 Aleah Bridgette Gadgode
35 Mae Amor Gorre
36 Christian John Alcopra
37 Rachelle Ann Arcadio
38 Alleah Dhynah Espina
39 Julius Lomo
40 Jhon Llorenz Sumalpong
41 Rafael English
42 Nathaniel Enoy
43 Eugenio Ferolino Jr.
44 Edriane Gonzales
45 Jhon Leo Perater
46 Zion Lee Wabe
47 Khier Malajay
48 Gen Archilles Arcadio
49 Felicity Grey Elopre
50 Princess Suishene Ricafranca
51 Miya Iyana Deniega
52 Merah Thea Ibrahim
53 Levien Polles
54 Princess Mae Polles
55 Myka Labajo
56 Marilyn Meñoza
TOTAL:
Prepared by:

MINDALYN M. ARIP
B. Deworming D. Actual Feeding
Feeding Teacher
( x ) - not dewormed (H ) - Present, served with Hot meals
Approved by: ( √ ) - dewormed (M ) - Present, served with Milk
(H/M ) - Present, served with Hot meals & Milk
ARIEL B. CRAMPATANTA EdD ( A ) - Absent, not served
Principal III (H2/M2/(H/M2)) - Present, served twice
Note: This form shall be prepared by the school to be consolidated using the Revised OKD Form A.
 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 53 54 55
1 Chandrey B. Edong
2 Prinz Seth Grethan P.
Fabra
3 Ethan Aziel
Falcarsantos
4 Rbien Yhalmerrz
Gimena
5 Mc Gabriel T. Padilla
6 Thaleah Cayleihn
Billones
7 Mary Chexter Carlisle
Garcia
8 Diana B. Lobiano
9 Abigail Kate Manogura
10 Athaliah Mendez
11 Angelic Faye P. Nazer
12 Khassandra L. Patria
13 Alleya A. Rabeza
14
Leica Angeleia
Rasonable
15 Brianna Zia Ricablanca
16 Sairah Jade I. Roleda
17 Benhor F. Baya
18 Paul Dexter Garcia
19 Thaian Gave Villanueva
20
Princess Yuanne D. De
Guzman
21 Trixhe T. Cabalida
22 Alleysha M. Camasora
23 April Ina Canton
24 Xhyra Glane Gabales
25 Ellery Neveah Laurea

page 2
26 Jewel S. Nemenzo
27 Christ Niña Vergara
28 Richelle Mae Ugdamina
29 Ash Heddriel Caste
30 Arianne Gimena
31 Leigh Angela Rasonable
32 Albert Cian Talledo
33 Isara Amray Espinas
34
Aleah Bridgette
Gadgode
35 Mae Amor Gorre
36 Christian John Alcopra
37 Rachelle Ann Arcadio
38 Alleah Dhynah Espina
39 Julius Lomo
40
Jhon Llorenz
Sumalpong
41 Rafael English
42 Nathaniel Enoy
43 Eugenio Ferolino Jr.
44 Edriane Gonzales
45 Jhon Leo Perater
46 Zion Lee Wabe
47 Khier Malajay
48 Gen Archilles Arcadio
49 Felicity Grey Elopre
50
Princess Suishene
Ricafranca
51 Miya Iyana Deniega
52 Merah Thea Ibrahim
53 Levien Polles
54 Princess Mae Polles
55 Myka Labajo
56 Marilyn Meñoza
TOTAL:

D. Actual Feeding

(H ) - Present, served with Hot meals

(M ) - Present, served with Milk
(H/M ) - Present, served with Hot meals & Milk
( A ) - Absent, not served
(H2/M2/(H/M2)) - Present, served twice

page 2
56 57 58 59 60

page 2
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 93 94 95
1 Chandrey B. Edong
2 Prinz Seth Grethan P.
Fabra
3 Ethan Aziel
Falcarsantos
4 Rbien Yhalmerrz
Gimena
5 Mc Gabriel T. Padilla
6 Thaleah Cayleihn
Billones
7 Mary Chexter Carlisle
Garcia
8 Diana B. Lobiano
9 Abigail Kate Manogura
10 Athaliah Mendez
11 Angelic Faye P. Nazer
12 Khassandra L. Patria
13 Alleya A. Rabeza
14
Leica Angeleia
Rasonable
15 Brianna Zia Ricablanca
16 Sairah Jade I. Roleda
17 Benhor F. Baya
18 Paul Dexter Garcia
19 Thaian Gave Villanueva
20
Princess Yuanne D. De
Guzman
21 Trixhe T. Cabalida
22 Alleysha M. Camasora
23 April Ina Canton
24 Xhyra Glane Gabales
25 Ellery Neveah Laurea

page 3
26 Jewel S. Nemenzo
27 Christ Niña Vergara
28 Richelle Mae Ugdamina
29 Ash Heddriel Caste
30 Arianne Gimena
31 Leigh Angela Rasonable
32 Albert Cian Talledo
33 Isara Amray Espinas
34
Aleah Bridgette
Gadgode
35 Mae Amor Gorre
36 Christian John Alcopra
37 Rachelle Ann Arcadio
38 Alleah Dhynah Espina
39 Julius Lomo
40
Jhon Llorenz
Sumalpong
41 Rafael English
42 Nathaniel Enoy
43 Eugenio Ferolino Jr.
44 Edriane Gonzales
45 Jhon Leo Perater
46 Zion Lee Wabe
47 Khier Malajay
48 Gen Archilles Arcadio
49 Felicity Grey Elopre
50
Princess Suishene
Ricafranca
51 Miya Iyana Deniega
52 Merah Thea Ibrahim
53 Levien Polles
54 Princess Mae Polles
55 Myka Labajo
56 Marilyn Meñoza
TOTAL:

D. Actual Feeding

(H ) - Present, served with Hot meals

(M ) - Present, served with Milk
(H/M ) - Present, served with Hot meals & Milk
( A ) - Absent, not served
(H2/M2/(H/M2)) - Present, served twice

page 3
96 97 98 99 100

page 3
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 No. of
Days Feeding Percentage
Present Days
101 102 103 104 105 106 107 108 109 110 111 112 113 114 115 116 117 118 119 120 (A) (B) (A/B)*100
1 Chandrey B. Edong 120 120 100
2 Prinz Seth Grethan P. 120 120 100
Fabra
3 Ethan Aziel 120 120 100
Falcarsantos
4 Rbien Yhalmerrz 120 120 100
Gimena
5 Mc Gabriel T. Padilla 120 120 100
6 Thaleah Cayleihn 120 120 100
Billones
7 Mary Chexter Carlisle 120 120 100
Garcia
8 Diana B. Lobiano 120 120 100
9 Abigail Kate Manogura 120 120 100
10 Athaliah Mendez 120 120 100
11 Angelic Faye P. Nazer 120 120 100
12 Khassandra L. Patria 120 120 100
13 Alleya A. Rabeza 120 120 100
14
Leica Angeleia
Rasonable 120 120 100
15 Brianna Zia Ricablanca 120 120 100
16 Sairah Jade I. Roleda 120 120 100
17 Benhor F. Baya 120 120 100
18 Paul Dexter Garcia 120 120 100
19 Thaian Gave Villanueva 120 120 100
20
Princess Yuanne D. De
Guzman 120 120 100
21 Trixhe T. Cabalida 120 120 100
22 Alleysha M. Camasora 120 120 100
23 April Ina Canton 120 120 100

page 4
24 Xhyra Glane Gabales 120 120 100
25 Ellery Neveah Laurea 120 120 100
26 Jewel S. Nemenzo 120 120 100
27 Christ Niña Vergara 120 120 100
28 Richelle Mae Ugdamina 120 120 100
29 Ash Heddriel Caste 120 120 100
30 Arianne Gimena 120 120 100
31 Leigh Angela Rasonable 120 120 100
32 Albert Cian Talledo 120 120 100
33 Isara Amray Espinas 120 120 100
34
Aleah Bridgette
Gadgode 120 120 100
35 Mae Amor Gorre 120 120 100
36 Christian John Alcopra 120 120 100
37 Rachelle Ann Arcadio 120 120 100
38 Alleah Dhynah Espina 120 120 100
39 Julius Lomo 120 120 100
40
Jhon Llorenz
Sumalpong 120 120 100
41 Rafael English 120 120 100
42 Nathaniel Enoy 120 120 100
43 Eugenio Ferolino Jr. 120 120 100
44 Edriane Gonzales 120 120 100
45 Jhon Leo Perater 120 120 100
46 Zion Lee Wabe 120 120 100
47 Khier Malajay 120 120 100
48 Gen Archilles Arcadio 120 120 100
49 Felicity Grey Elopre 120 120 100
50
Princess Suishene
Ricafranca 120 120 100
51 Miya Iyana Deniega 120 120 100
52 Merah Thea Ibrahim 120 120 100
53 Levien Polles 120 120 100
54 Princess Mae Polles 120 120 100
55 Myka Labajo 120 120 100
56 Marilyn Meñoza 120 120 100
TOTAL: AVERAGE:

D. Actual Feeding

(H ) - Present, served with Hot meals

(M ) - Present, served with Milk

page 4
 (H/M ) - Present, served with Hot meals & Milk
( A ) - Absent, not served
(H2/M2/(H/M2)) - Present, served twice

page 4
SBFP Form 5 (2020)

DEPARTMENT OF EDUCATION
Region ____

REGION/DIVISION/DISTRICT: ____________________________________________________________________
NAME OF SCHOOL: ____________________________________________________________________
SCHOOL ID NO.: ____________________________________________________________________

SCHOOL-BASED FEEDING PROGRAM - MILK COMPONENT

LIST OF AUTHORIZED CONSIGNEES (SY________)

NAME & DESIGNATION TEL. NO. MOBILE NO. EMAIL ADD SPECIMEN
SIGNATURE
1 (School Head)

2 (School Feeding Coordinator)

3 (School Property Custodian)

SCHOOL INSPECTION TEAM (SY________)

NAME & DESIGNATION TEL. NO. MOBILE NO. EMAIL ADD SPECIMEN
SIGNATURE
1

3
SBFP Form 5 (2020)

Note: Only authorized consignees are allowed to receive the goods.

SBFP Form 5 (2021)

DEPARTMENT OF EDUCATION
Region ___

REGION/DIVISION/DISTRICT: ______________________________________________________________________________
NAME OF SCHOOL: ______________________________________________________________________________
SCHOOL ID NO.: ______________________________________________________________________________

SCHOOL-BASED FEEDING PROGRAM - MILK COMPONENT

LIST OF BENEFICIARIES (SY________)

Classification of Students in terms of Milk Tolerance
(Please check one)
Without milk With milk Not allowed by
intolerance and intolerance but parents to
Name Grade & Section will participate in willing to participate in
milk feeding participate in milk milk feeding
feeding
SBFP Form 5 (2021)

Prepared by: APPROVED BY:

School Feeding Coordinator School Head

SBFP Form 6 (2021)

DEPARTMENT OF EDUCATION
Region ___

REGION/DIVISION/DISTRICT: ______________________________________________________________________________
NAME OF SCHOOL: ______________________________________________________________________________
SCHOOL ID NO.: ______________________________________________________________________________

SCHOOL-BASED FEEDING PROGRAM

NFP DELIVERIES (SY________)

Grade Level Number of Date No. of Packs Received No. of Packs for Remarks
Beneficiaries Delivered Replacement/
New Replacemen Total (New + Rejected
t Replacement)
Kinder
Grade 1
Grade 2
Grade 3
Grade 4
Grade 5
Grade 6
TOTAL:

MILK DELIVERIES (SY________)

Grade Level Number of Date No. of Packs Received No. of Packs for Remarks
Beneficiaries Delivered Replacement/
New Replacemen Total (New + Rejected
t Replacement)
Kinder
Grade 1
Grade 2
Grade 3
Grade 4
Grade 5
Grade 6
TOTAL:
SBFP Form 6 (2021)

Prepared by: APPROVED BY:

School Feeding Coordinator School Head