SBFP Form 1 (2020)

Department of Education
Region __VIII_

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

Division/Province: ___________ NORTHERN SAMAR Name of Principal : MA. LAURENE C. DENURA

City/ Municipality/Barangay : ________ LAOANG Name of Feeding Focal Person : _ NICOLE B. CABRASAWAN
Name of School / School District : ___ ROMBANG ELEMENTARY SCHOOL
School ID Number: ___________ 122944

BMI Nutritional Parent's

Participation Beneficiary of
Grade/ Date of Weighing / Age in Weight Height for 6
Status (NS) Dewormed consent for
in 4Ps SBFP in
Date of Birth
No. Name Sex Measuring Years / y.o. ? milk?
Section (MM/DD/YYYY) (MM/DD/YYYY) Months (Kg) (m)
and (yes or no) (yes or
(yes or Previous Years
no) (yes or no)
above no)
BMI-A HFA
1 GUERRERO, MYRA LOU F KINDER 3/30/2018 8-Sep-24 5.05 13.6 0.88 17.48 N SS YES YES NO
2 PINCA, ALEXA F 1 4/6/2017 8-Sep-24 6.03 13.3 1.06 11.79 W N YES NO NO
3 ACUIN, JEMIE B. M 1 06/13/2015 8-Sep-24 5.07 28 1.28 SW N YES NO YES
4 ACUIN, JAY M 1 08/25/2018 8-Sep-24 5.07 29 1.25 W N YES NO NO
5 PANTE, RIZA C, F 2 9/6/2016 8-Sep-24 5.09 27.3 1.26 11.3 SW N YES YES YES
6 PIGAR,JIO L. M 3 8/12/2014 8-Sep-24 6.04 26.5 1.25 12.15 SW N YES YES YES
7 BALUYOT, DANILEEN F 3 08/17/2014 8-Sep-24 9 20.5 1.28 12.45 w N YES YES YES
8 CRISTOBAL,ARNOLD JR. M 3 3/7/2014 8-Sep-24 9.02 19.5 1.17 14.22 N S YES NO YES
9 GIMENA, DENVER N. M 3 03/29/2015 8-Sep-24 8.05 19.5 1.17 14.69 N S YES YES YES
10 BALUYOT, DAN M 4 03/30/2012 8-Sep-24 11.05 23.5 1.34 13.19 W N YES YES YES
11 BALUYOT,EDRIAN M 4 01/15/2014 8-Sep-24 9.07 23.5 1.25 13.2 W N YES YES YES
12 VILLAMOR, MAR M 4 02/25/2013 8-Sep-24 10.06 25 1.35 13.78 W N YES YES YES
13 BALANLAY, REHANNA JANE F 4 12/11/2013 8-Sep-24 9.09 22 1.22 14.68 N S YES YES YES
14 PIGAR,JENELYN F 4 12/3/2014 8-Sep-24 9.05 22 1.19 15.61 N S YES YES YES
15 PINCA,KRISTEL F 4 5/8/2014 8-Sep-24 9.01 18 1.17 13.26 N S YES YES YES
16 GUERRERO, MARK CARLO M 5 02/28/2008 8-Sep-24 15.06 31 1.42 15.48 W SS YES YES YES
17 ACEDERA,ROGELYN O. F 5 3/12/2013 8-Sep-24 9.09 23 1.34 12.87 W N YES YES YES
18 CRISTOBAL,CELEIENE C. F 5 09/14/2013 8-Sep-24 9.11 22..50 1.32 12.84 W N YES NO YES
19 ACUIN, MAR JHON C. M 5 04/22/2013 8-Sep-24 10.04 21 1.21 14.25 N S YES YES YES
20 BALUYOT,JERALD ROBLES M 5 10/25/2011 8-Sep-24 11.1 26.5 1.3 15.61 N S YES YES YES
 21 PINCA,PRINCE L. M 5 03/27/2013 8-Sep-24 10.05 24.5 1.26 15.51 N S YES NO YES
22 DY,RENELYN P. F 5 09/22/2012 8-Sep-24 10.11 31.5 1.29 18.84 N S YES YES YES
23 MARTINEZ,SOPHIA S. F 5 5/1/2013 8-Sep-24 10.08 26 1.28 15.8 N S YES YES YES
24 PIGAR,JELIAN L. F 5 04/20/2012 8-Sep-24 11.04 24.5 1.27 15.31 N SS YES YES YES
25 PINCA, PRINCESS F 5 03/27/2013 8-Sep-24 10.05 24.5 1.23 16 N S YES YES YES
26 MERCADER,JHIONEL M 6 09/18/2011 8-Sep-24 11.11 25 1.33 14.13 W S YES NO YES
27 PELEGRINO, REIGN M 6 8/9/2012 8-Sep-24 11 25 1.25 15.97 N S YES YES YES

Prepared by:
Approved by:

NICOLE B. CABRASAWAN MA. LAURENE C. DENURA

Feeding Focal Person School Head

Note: This form shall be prepared by the school before the start of feeding to be compiled by the SDO.
SBFP Form 2 (2020)
Department of Education
Region __VIII_

SCHOOL-BASED FEEDING PROGRAM (SBFP) LIST OF SCHOOLS (SY__2023-2024______)

Division/Province: ___________________________ NORTHERN SAMAR/LAOANG

School District/City/ Municipality : ______________ LAOANG V DISTRICT/LAOANG

Name of District
Contact Number or & Total
Name of Schools BEIS ID No. School Address Name of Barangay Supervisors/
Email Address Beneficiaries
School Principal or OICs

Rombang Elementary School Brgy. Rombang, Laoang N. SamBrgy. Rombang Ma. Laurene C, Denura 9267069657 27

Prepared by: Approved by:

NICOLE B. CABRASAWAN MA. LAURENE C. DENURA

SBFP DepED Focal School Head

Note: This form shall be prepared by the SDO before the start of feeding, for final consolidation by the RO.
SBFP Form 3 (2020)
Department of Education
Region _VIII__

SCHOOL-BASED FEEDING PROGRAM (SBFP) SUMMARY OF BENEFICIARIES & START OF FEEDING (SY_2023-2024_)
Division/Province: ___________ NORTHERN SAMAR
City/ Municipality/Barangay : __ LAOANG/ROMBANG
Name of School / School District ROMBANG ELEM. SCHOOL/ LAOANG V
School ID Number: __________ 122944
Date of Start of Feeding: _____ JANUARY 10,2024
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
SW W N OW+O SS S N T No. of Pupils- No. of No. of No. of Dewormed beneficiaries
Number of Undernourished School at-risk-of- in previous
Children by Grade Level Stunted/ Indigent Indigenous
dropping-out years
Severely Learners Peoples (IPs) (Repeaters)
(PARDOs) Stunted

1. Kinder 0 0 6 0 1 0 5 0 0 1 0 0 6 1 0 JANUARY 10,2024

2. Grade I 1 3 4 1 0 1 8 0 0 1 0 0 9 0 0 JANUARY 10,2024

3. Grade II 1 0 12 0 0 0 13 0 0 0 0 0 13 1 1 JANUARY 10,2024

4. Grade III 1 1 14 0 0 2 14 0 0 0 0 0 16 3 4 JANUARY 10,2024

5. Grade IV 0 3 13 0 0 3 13 0 0 0 0 0 16 6 6 JANUARY 10,2024

6. Grade V 0 3 18 0 2 5 14 0 0 2 0 0 21 8 10 JANUARY 10,2024

7. Grade VI 0 1 11 0 0 2 10 0 0 0 0 0 12 1 2 JANUARY 10,2024

Total 3 11 78 1 3 13 77 0 0 3 0 0 93 20 23

Prepared by: Approved by:

NICOLE B. CABRASAWAN MA. LAURENE C. DENURA

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 4 (2020)
SCHOOL-BASED FEEDING PROGRAM
RECORD OF DAILY FEEDING

FOR THE MONTH OF _______________ , SY ___2022-2023_________

Region ________________VIII____________
Division _________NORTHERN SAMAR__________________ School: ______ ROMBANG ELEMENTARY SCHOOL
District ____________LAOANG V DISTRICT_______________ Grade: K-6
School ID Number: __ 122944
NAME OF PUPIL ACTUAL FEEDING

1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16

1 ACEDERA, JHON CARLO T. M M M M M M M M M M M M M M M M

2 BALANLAY, RIO JADE B. M M M M M M M M M M M M M M M M
3 BALDEVIZO, ANDREW, H M M M M M M M M M M M M M M M M
4 BALDEVIZO, ANDREY H. M M M M M M M M M M M M M M M M
5 BALUYOT, KEN KAISER M. M M M M M M M M M M M M M M M M
6 PIGAR, JIMAR B. M M M M M M M M M M M M M M M M
7 POSO, ZETH LEXUS, E. M M M M M M M M M M M M M M M M
8 SIENA, ROBERTSON, JR. L. M M M M M M M M M M M M M M M M
9 VELEZ, JASON , B. M M M M M M M M M M M M M M M M
10 ACUIN, JOYLYN , B. M M M M M M M M M M M M M M M M
11 BALANLAY,LEALYN, M. M M M M M M M M M M M M M M M M
12 BALUYOT, TRISHA MAE, P. M M M M M M M M M M M M M M M M
13 MERCADER, MARY JOY, G. M M M M M M M M M M M M M M M M
14 PANTE, RIZA, C. M M M M M M M M M M M M M M M M
15 PELEGRINO, REMHEL, M M M M M M M M M M M M M M M M
16 BALANLAY, REHANNA JANE M M M M M M M M M M M M M M M M
17 BALUYOT, DAN M M M M M M M M M M M M M M M M
18 BALUYOT, ADRIAN M M M M M M M M M M M M M M M M
19 PIGAR, JENELYN M M M M M M M M M M M M M M M M
20 PINCA, KRYSTEL M M M M M M M M M M M M M M M M
21 VILLAMOR, MAR M M M M M M M M M M M M M M M M
22 ACEDERA, JEHAN M M M M M M M M M M M M M M M M
23 ACUIN, JOCELLE M M M M M M M M M M M M M M M M
24 ACUIN, MARJJHON M M M M M M M M M M M M M M M M
25 BALANLAY, ALTHEA JANE M M M M M M M M M M M M M M M M
26 BALUYOT, LIZ ANNE M M M M M M M M M M M M M M M M
27 BALUYOT, JASMINE M M M M M M M M M M M M M M M M
28 CRISTOBAL, CELEINE M M M M M M M M M M M M M M M M
29 DY,RENELYN, M M M M M M M M M M M M M M M M
30 GUERRERO, MALOU M M M M M M M M M M M M M M M M
31 IRINCO, REY ANN M M M M M M M M M M M M M M M M
32 PIGAR, JELIAN M M M M M M M M M M M M M M M M
33 PINCA, PRINCE M M M M M M M M M M M M M M M M
34 PINCA, PRINCESS M M M M M M M M M M M M M M M M
35 ACEDERA, ROGELYN M M M M M M M M M M M M M M M M
36 MERCADER, KATRYN M M M M M M M M M M M M M M M M
37 PELEGRINO, REIGN M M M M M M M M M M M M M M M M
38 MERCADER, JHIONEL M M M M M M M M M M M M M M M M

TOTAL: 38 38 38 38 38
Prepared by:

NICOLE B. CABRASAWAN
B. Deworming D. Actual Feeding
Feeding Teacher / School Nurse
( 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
MA. LAURENE C. DENURA ( A ) - Absent, not served
School Head (H2/M2/(H/M2)) - Present, served twice

Page 5
Note: This form shall be prepared by the school to be consolidated using the Revised OKD Form A.

Page 6
 SBFP Form 4 (2020)

SCHOOL-BASED FEEDING PROGRAM

FOR THE MONTH OF _______________ , SY _____________

Region _____________VIII_______________
Division _____________NORTHERN SAMAR______________ School: ___ ROMBANG ELEMENTARY SCHOOL
District ____ LAOANG V DISTRICT Grade: __________ Section _____________________
School ID Number: __ 122944

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
21
22
23
24
25
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
 SBFP Form 4 (2020)

SCHOOL-BASED FEEDING PROGRAM

FOR THE MONTH OF ______________________ , SY _____________

Region ____________________________
Division ___________________________ School: _____________________________________
District ___________________________ Grade: __________ Section _____________________
School ID Number: _________________________

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
21
22
23
24
25
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
 SBFP Form 4 (2020)

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
(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:

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 4
 SBFP Form 5 (2020)

DEPARTMENT OF EDUCATION
Region __VIII__

REGION/DIVISION/DISTRICT: ____________________________ VIII/ NORTHERN SAMAR/ LAOANG V DISTRICT

NAME OF SCHOOL: ________________________ ROMBANG ELEMENTARY SCHOOL
SCHOOL ID NO.: ______________________ 122944

SCHOOL-BASED FEEDING PROGRAM - MILK

LIST OF AUTHORIZED CONSIGNEES (SY__2022-2023____)

NAME & DESIGNATION TEL. NO. MOBILE NO. EMAIL ADD SPECIMEN
SIGNATURE
1 MA. LAURENE C. DENURA(School Head) 9267069657 malaurene.corocoto@deped.gov.ph

2 NICOLE B. CABRASAWAN(School Feeding Coordinat 9667798465 nicole.cabrasawan@deped.gov.ph

3 MARITES B. GIRAY (School Property Custodian) 9468056020 marites_giray@deped.gov.ph

Note: This form shall be filled-up by School Drop-off points to be given to the NDA/Dairy Cooperative supplier on the first
delivery of milk. Only authorized consignees are allowed to receive the goods.
 SBFP Form 6 (2020)

DEPARTMENT OF EDUCATION
Region __VIII_

REGION/DIVISION/DISTRICT: ____________ VIII//NORTHERN SAMAR/LAOANG V DISTRICT

NAME OF SCHOOL: _______ ROMBANG ELEMENTARY SCHOOL
SCHOOL ID NO.: ____ 122944

SCHOOL-BASED FEEDING PROGRAM - MILK COMPONENT

LIST OF BENEFICIARIES (SY_____2022-2023___)

(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 ACEDERA, JHON CARLO T. KINDER-PLATO /
2 BALANLAY, RIO JADE B. KINDER-PLATO /
3 BALDEVIZO, ANDREW H. KINDER-PLATO /
4 BALDEVIZO, ANDREY H. KINDER-PLATO /
5 BALUYOT, KEN KAISER M. KINDER-PLATO /
6 PIGAR, JIMAR B. KINDER-PLATO /
7 POSO, ZETH LEXUS E. KINDER-PLATO /
8 SIENA, ROBERTSON JR L. KINDER-PLATO /
9 VELEZ, JASON B. KINDER-PLATO /
10 ACUIN, JOYLYN B. KINDER-PLATO /
11 BALANLAY, LEALYN M. KINDER-PLATO /
12 BALUYOT, TRISHA MAE P. KINDER-PLATO /
13 MERCADER , MARY JOY G. KINDER-PLATO /
14 PANTE, RIZA C. KINDER-PLATO /
15 PELEGRINO, REMHEL TWO-GUTTENBERG /
16 BALANLAY, REHANNA JANE THREE-NEWTON /
17 BALUYOT , DAN THREE-NEWTON /
18 BALUYOT, ADRIAN THREE-NEWTON /
19 PIGAR, JENELYN THREE-NEWTON /
20 PINCA, KRYSTEL THREE-NEWTON /
21 VILLAMOR, MAR THREE-NEWTON /
22 ACEDERA, JEHAN FOUR-BELL /
23 ACUIN, JOCELLE FOUR-BELL /
24 ACUIN, MARJJJHON FOUR-BELL /
25 BALANLAY, ALTHEA JANE FOUR-BELL /
26 BALUYOT, LIZ ANNE FOUR-BELL /
27 BALUYOT, JASMINE FOUR-BELL /
28 CRISTOBAL, CELEINE FOUR-BELL /
29 DY, RENELLYN FOUR-BELL /
30 GUERRERO, MALOU FOUR-BELL /
31 IRINCO, REY ANN FOUR-BELL /
32 PIGAR, JELIAN FOUR-BELL /
33 PINCA, PRINCE FOUR-BELL /
34 PINCA, PRINCESS FOUR-BELL /
35 ACEDERA, ROGELYN FOUR-BELL /
36 MERCADER, KATRYN FIVE-GALILEO /
37 PELEGRINO, REIGN FIVE-GALILEO /
38 MERCADER, JHIONEL FIVE-GALILEO /
Prepared by: APPROVED BY:

NICOLE B. CABRASAWAN MA. LAURENE C. DENURA

School Feeding Coordinator School Head
 SBFP Form 7 (2020)

DEPARTMENT OF EDUCATION
Region __VIII_

REGION/DIVISION/DISTRICT: ________________ VIII/NORTHERN SAMAR/LAOANG V DISTRICT

NAME OF SCHOOL: ___________ ROMBANG ELEMENTARY SCHOOL
SCHOOL ID NO.: _________ 122944

SCHOOL-BASED FEEDING PROGRAM - MILK COMPONENT

MILK DELIVERIES (SY 2022-2023)

Grade Level Number of Beneficiaries Date No. of Packs Received No. of Packs for
Delivered Replacement/
New Replacement Total (New + Rejected
Replacement)
Kinder 1 Dec. 1, 2023 608 0 608 0
Grade 1 3
Grade 2 1
Grade 3 4
Grade 4 6
Grade 5 10
Grade 6 2
TOTAL: 27
Prepared by: APPROVED BY:

NICOLE B. CABRASAWAN MA. LAURENE C. DENURA

School Feeding Coordinator School Head
 SBFP Form 7 (2020)

MENT OF EDUCATION
Region __VIII_

NG PROGRAM - MILK COMPONENT

VERIES (SY 2022-2023)

Remarks
 SBFP Form 7 (2020)

DEPARTMENT OF EDUCATION
Region __VIII_

REGION/DIVISION/DISTRICT: __________ VIII/ NORTHERN SAMAR/ LAOANG V DISTRICT

NAME OF SCHOOL: _____ ROMBANG ELEMENTARY SCHOOL
SCHOOL ID NO.: __ 122944

SCHOOL-BASED FEEDING PROGRAM - MILK COMPONENT

MILK DELIVERIES (SY__2022-2023______) FOR DROP-OFF POINTS

Date Delivered No. of Packs Received Allocation per School

New Replacement Total (New + Schools Number of

Replacement) Beneficiries
December 1, 2023 608 0 608 1.Rombang Elementary Sch 38

2
3
4
5
6
7
8
9
10

TOTAL:

Date Delivered No. of Packs Received Allocation per School

New Replacement Total (New + Schools Number of
Replacement) Beneficiries
2 1
2
3
4
5
6
7
8
9
10
TOTAL:

Date Delivered No. of Packs Received Allocation per School

New Replacement Total (New + Schools Number of
Replacement) Beneficiries
3 1
2
3
4
5
6
 SBFP Form 7 (2020)

7
8
9
10
TOTAL:

Date Delivered No. of Packs Received Allocation per School

New Replacement Total (New + Schools Number of
Replacement) Beneficiries
4 1
2
3
4
5
6
7
8
9
10
TOTAL:

Date Delivered No. of Packs Received Allocation per School

New Replacement Total (New + Schools Number of
Replacement) Beneficiries
5 1
2
3
4
5
6
7
8
9
10
TOTAL:

Date Delivered No. of Packs Received Allocation per School

New Replacement Total (New + Schools Number of
Replacement) Beneficiries
6 1
2
3
4
5
6
7
8
9
10
TOTAL:

Date Delivered No. of Packs Received Allocation per School

New Replacement Total (New + Schools Number of
Replacement) Beneficiries
7 1
 SBFP Form 7 (2020)
7
2
3
4
5
6
7
8
9
10
TOTAL:

Date Delivered No. of Packs Received Allocation per School

New Replacement Total (New + Schools Number of
Replacement) Beneficiries
8 1
2
3
4
5
6
7
8
9
10
TOTAL:

Prepared by: APPROVED BY:

NICOLE B. CABRASAWAN MA. LAURENE C. DENURA

School Feeding Coordinator School Head
 SBFP Form 7 (2020)

ENT OF EDUCATION
egion __VIII_

NG PROGRAM - MILK COMPONENT

2-2023______) FOR DROP-OFF POINTS

Allocation per School

Number of Milk
Allocation
608 packs

Allocation per School

Number of Milk
Allocation

Allocation per School

Number of Milk
Allocation
SBFP Form 7 (2020)

Allocation per School

Number of Milk
Allocation

Allocation per School

Number of Milk
Allocation

Allocation per School

Number of Milk
Allocation

Allocation per School

Number of Milk
Allocation
SBFP Form 7 (2020)

Allocation per School

Number of Milk
Allocation
SBFP Form 8 (2020)

DEPARTMENT OF EDUCATION
Region ___

SCHOOL-BASED FEEDING PROGRAM MONTHLY/QUARTERLY REPORT (SY________)

Region/Division: ____________________

Financial Status

Status of Implementation
(when Amount Liquidation Remarks (state if
Target No. Actual No. % Status of
No. of SDO started, completed, Downloaded fully/partially
Division/Schools of SBFP of SBFP downloading of
Schools (SBFP discontinue, for Amount to /Received liquidated &
Schools Schools Schools/SDO funds to Schools Disbursed
Schools) continuation or number of Allocated by SDOs or reason)
or to NDA/PCC for
feeding days completed) NDA/PCC 1st 2nd
milk
for milk

Prepared by: Approved by:

RO/SDO Focal Person Regional Director/ Schools Division Superintendent

RO/SDO Accountant