SBFP Form 1 (2021)

Department of Education
Region Caraga

Master List Beneficiaries for School-Based Feeding Program (SBFP) (SY 2022-2023)

Division/Province: AGUSAN DEL SUR Name of Principal : LUZMINDA C. SAGUIDON

City/ Municipality/Barangay : ESPERANZA / DUANGAN Name of Feeding Focal Person : LEONARD E. ESCARDA
Name of School / School District : DUANGAN ELEMENTARY SCHOOL / ESPERANZA DISTRICT II
School ID Number: 131702

Nutritional Parent's Beneficiary of

BMI for Dewormed? consent for Participatio
Grade/ Date of Birth Date of Weighing / Age in Weight Height 6 y.o. Status (NS) n in 4Ps
SBFP in
No. Name Sex Section
Measuring Years / milk? Previous
(MM/DD/YYYY) Months (Kg) (cm) and (yes
(MM/DD/YYYY)
(yes or no) (yes or Years (yes or
above no) or no) no)
BMI-A HFA
Kindergarten 19
1 ADRAN,NOEL JR D. M Orchids
3/6/2017 9/9/2022 5 109 N N Yes Yes No No
Kindergarten
2 ALABAT,RONEL N. M 11/25/2016 9/9/2022 5 18.5 104 N S Yes Yes Yes No
Orchids
Kindergarten 16.5
3 ANGGOT,BRENT D. M Orchids
7/7/2017 9/9/2022 5 105 N N Yes Yes No No
Kindergarten 16
4 BACSARPA,ZAIRUS A. M Orchids
02/27/2017 9/9/2022 5 102 N S Yes Yes No No
Kindergarten 16.5
5 BACSARPA,ZEUS, A. M Orchids
02/27/2017 9/9/2022 5 104 N N Yes Yes No No
Kindergarten
6 CASAL,JAYSON, JR A. M 06/14/2017 9/9/2022 5 16 102 N N Yes Yes No No
Orchids
Kindergarten 15.5
7 CORDOVA,AIRO NORAIN, M. M Orchids
09/20/2016 9/9/2022 5 103 W S Yes Yes No No
Kindergarten 19 15.4
8 CULIAO,JOHN JEMMUEL, M. M Orchids
4/12/2015 9/9/2022 6 111 N N Yes Yes No No
Kindergarten 25
9 DAUGDAUG,JOHN FORD, P. M Orchids
11/12/2016 9/9/2022 5 117 N N Yes Yes No No
Kindergarten
10 DELIMA,JOEL, - M 10/24/2017 9/9/2022 5 19 104 N N Yes Yes No No
Orchids
Kindergarten 20
11 DENOYAN,NILO, JR R. M Orchids
08/28/2017 9/9/2022 5 113 N N Yes Yes Yes No
Kindergarten 19
12 DURANGO,LANCE, P. M Orchids
6/2/2017 9/9/2022 5 105 N N Yes Yes No No
Kindergarten
13 MELENDREZ,MARK RYAN, U. M 3/4/2017 9/9/2022 5 15.5 104 N N Yes Yes No No
Orchids
Kindergarten 21.5
14 MENDEZ,PHILIP JOSHUA, G. M Orchids
8/1/2017 9/9/2022 5 111 N N Yes Yes Yes No
Kindergarten 17
15 NATAD,XION JAZZER, C. M Orchids
04/25/2017 9/9/2022 5 107 N N Yes Yes No No
Kindergarten
16 OPON,PRINCE AJ, B. M 10/26/2016 9/9/2022 5 16.5 110 N N Yes Yes No No
Orchids
Kindergarten 19
17 PLAZO,JHON CARL, T. M Orchids
04/24/2017 9/9/2022 5 106 N N Yes Yes Yes No
Kindergarten 19.5 15.5
18 QUIGOD,GLENN, JR P. M Orchids
7/9/2016 9/9/2022 6 112 N N Yes Yes Yes No
Kindergarten 16
19 SARMIENTO,EZEQUIL, T. M Orchids
01/23/2017 9/9/2022 5 101 N S Yes Yes No No
Kindergarten
20 TAW-ON,CHARLS REVIN, - M 01/24/2017 9/9/2022 5 19 107 N N Yes Yes No No
Orchids
Kindergarten 15
21 ADOLFO,HOPE, P. F Orchids
2/8/2017 9/9/2022 5 99 N S Yes Yes Yes No
Kindergarten 16
22 AGUSTIN,SHYRA, C. F Orchids
10/27/2017 9/9/2022 5 105 N N Yes Yes No No
Kindergarten
23 BACSARPA,CHERRY VIA A. F 10/22/2017 9/9/2022 5 18 107 N N Yes Yes No No
Orchids
Kindergarten 15
24 BAUTISTA,EDELYN, A. F Orchids
8/9/2017 9/9/2022 5 101 N N Yes Yes No No
Kindergarten 14
25 COBOL,ZYHT MYRRH F Orchids
10/18/2017 9/9/2022 5 101 N N Yes Yes Yes No
Kindergarten 17
26 DENOYAN,DESSIRE, R. F Orchids
12/12/2016 9/9/2022 5 105 N N Yes Yes No No
Kindergarten
27 DENOYAN,JOYCE, T. F 06/28/2016 9/9/2022 6 17 104 15.7 N S Yes Yes Yes No
Orchids
Kindergarten
28 DONALDO,JESHIENE MAE, S. F 05/25/2017 9/9/2022 5 14.5 101 N N Yes Yes No No
Orchids
Kindergarten 15
29 GUARDE,ZANDRA FAYE, B. F Orchids
06/25/2017 9/9/2022 5 105 N N Yes Yes No No
Kindergarten 16.5
30 KEBAN,RESLIE, - F Orchids
1/2/2017 9/9/2022 5 101 N S Yes Yes No No
Kindergarten
31 PLAZO,MICA, A. F 03/16/2016 9/9/2022 6 14 102 13.4 N S Yes Yes No No
Orchids
Kindergarten 15.5
32 PRATO,JELLIANE, D. F Orchids
10/08/2017 9/9/2022 5 101 N N Yes Yes Yes No
Kindergarten 15.5
33 ROMAGOS,JESSA, G. F Orchids
01/12/2017 9/9/2022 5 102 N S Yes Yes No No
Grade I
34 BERESO, JANE ELHAVE RHELLE T. F
Rose
12/20/2015 9/9/2022 6 14.5 107 12.6 W S Yes Yes Yes Yes
Grade I
35 LARGO, CAITRYLLE MAE M.
F
Rose
10/16/2016 9/9/2022 6 14.5 107 W N Yes Yes Yes Yes
Grade II
36 BABA, JOSIAH R. M
Daisy
6/4/2015 9/9/2022 7 18 117 13.1 W N Yes Yes Yes Yes
Grade IV
37 CANGCO, ARJEVAL P. M
Gumamela
12/18/2012 9/9/2022 12 18 119 12.7 W N Yes Yes Yes Yes
Grade V
38 DENOYAN, FULL KING T. M
Dahlia
01/30/2012 9/9/2022 10 21 127 14 W S Yes Yes Yes Yes
Grade V
39 PLAZO, KIM JAY A. M
Dahlia
06/30/2011 9/9/2022 11 22 125 14 W S Yes Yes Yes Yes
Grade V
40 RIGUIS, JAY JR. T.
M
Dahlia
08/29/2012 9/9/2022 10 24 133 13.5 W N Yes Yes Yes Yes

Prepared by: Approved by:

(COUNTER SIGN Nurse) LUZMINDA C. SAGUIDON

LEONARD E. ESCARDA School Head
Feeding Focal Person

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 / DUANGAN
Name of School / School District : DUANGAN ELEMENTARY SCHOOL / ESPERANZA DISTRICT II
School ID Number: 131702
Date of Start of Feeding: __________________________
Last Mile School: ___Y / N
Nutritional Status at Start/End of Feeding No. of Secondary Targets No. of 4 No. of 4 No. of Pupils Date
Learners Ps who are Feeding
Number of SW W N OW+O SS S N T No. of Pupils- No. of No. of No. of Dewormed Beneficia beneficiaries in
previous years Started/End
Undernourished School at-risk-of- Stunted/ Indigent Indigenous ries
dropping-out (Repeaters) ed
Children by Grade Level Severely Learners Peoples (IPs)
(PARDOs) Stunted

1. Kinder 0 1 32 33 9 0

2. Grade I O 2 2 2 2
3. Grade II O 1 1 1 1

4. Grade III O O 0 0 0
5. Grade IV O 1 1 1 1
6. Grade V 2 1 3 3 3

7. Grade VI 0 0 0 0 0
Total 2 6 32 0 0 0 0 0 0 0 0 0 40 16 7

Prepared by: Approved by:

(COUNTER SIGN Nurse)

LEONARD E. ESCARDA LUZMINDA C. SAGUIDON
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 5 (2020)

DEPARTMENT OF EDUCATION
Region CARAGA

REGION/DIVISION/DISTRICT: CARAGA/AGUSAN DEL SUR/ ESPERANZA DISTRICT II

NAME OF SCHOOL: DUANGAN ELEMENTARY SCHOOL
SCHOOL ID NO.: 131702

SCHOOL-BASED FEEDING PROGRAM - NFP/MILK

LIST OF AUTHORIZED CONSIGNEES (SY 2022-2023)

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

(School Head)
1 NONE 9514606148
LUZMINDA C. SAGUIDON
[email protected]
(School Feeding Coordinator)
2 NONE 9054456070
LEONARD E. ESCARDA
[email protected]

(School Property Custodian)

3 NONE 9203302723
MARISA M. CANDANO
[email protected]

SCHOOL INSPECTION TEAM (SY 2021-2022)

NAME & DESIGNATION TEL. NO. MOBILE NO. EMAIL ADD SPECIMEN
SIGNATURE
1
ANNA LIZA B. NERI NONE 9455795372
[email protected]
2
IRENE M. ARREZA NONE 9511999408
[email protected]
3
LILIBETH J. AMOGUIS NONE 9306990154
[email protected]
SBFP Form 5 (2020)

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