SBFP Form 1 (2020)

Department of Education
Region VII

Master List Beneficiaries for School-Based Feeding Program (SBFP) (SY2021-2022)

Division/Province: BOHOL Name of Principal : ROWEL B. GULTIAN

City/ Municipality/Barangay : DUSITA, SIERRA BULLONES Name of Feeding Focal Person : VERGIE A. SUASO
Name of School / School District : DUSITA ELEMENTARY SCHOOL
School ID Number: 118682

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) (cm)
and (yes or no) (yes or
(yes or Previous Years
no) (yes or no)
above no)
BMI-A HFA
1 ARAGON, ARIES I M Kinder 3/25/2015
2 MAPANG, SKYLAR LUKE B. M Kinder 2/18/2016
3 ARAPO, HONEYLETH SKYE M Kinder 10/26/2016
4 CADELIŇA, MAUMIE C. M Kinder 4/19/2016
5 MAGDAYO, ALLIA JANE M. M Kinder 4/21/2016
6 RETARDO, JANELLE ROSE J. M Kinder 3/24/2016

Prepared by: Approved by:

LOWELL A. AMAZA
_____VERGIE A. SUASO 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.
SBFP Form 2 (2020)
Department of Education
Region : VII

SCHOOL-BASED FEEDING PROGRAM (SBFP) LIST OF SCHOOLS (SY:2021-2022)

Division/Province: BOHOL
School District/City/ Municipality : SIERRA BULLONES

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

DUSITA ES 118682 DUSITA SIERRA BULLONES DUSITA LOWELL A. AMAZA lowell.amaza 01deped.gov.ph 6

Prepared by: Approved by:

VERGIE A. SUASO BIANITO A. DAGATAN EdD, CESO V

SBFP DepED Focal Schools Division Superintendent

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 ___

SCHOOL-BASED FEEDING PROGRAM (SBFP) SUMMARY OF BENEFICIARIES & START OF FEEDING (SY________)
Division/Province: ______________________________________
City/ Municipality/Barangay : ____________________________
Name of School / School District : _________________________
School ID Number: _________________________
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 Ps No. of Pupils
Learners Beneficiaries who are
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

2. Grade I

3. Grade II

4. Grade III

5. Grade IV

6. Grade V

7. Grade VI

Total

Prepared by: Approved by:

______________________________________
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
 Date Feeding
Started/Ended

DepEd BLSS-SHD
 SBFP Form 4 (2020)
SCHOOL-BASED FEEDING PROGRAM
RECORD OF DAILY FEEDING

FOR THE MONTH OF __NOVEMBER-DECEMBER , SY _____2021-2022

Region VII
Division _____BOHOL______________________ School: _____ DUSITA ELEMENTARY
District ___SIERRA BULLONES Grade: K Section
School ID Number: _ 118682
NAME OF PUPIL ACTUAL FEEDING

1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20
1 ARAGON, ARIES I. ü
2 MAPANG, SKYLAR LUKE B. ü
3 ARAPO, HONEYLETH SKYE
4 CADELIŇA, MAUMIE C.
5 MAGDAYO, ALLIAJANE M.
6 RETARDO, JANELLE ROSE J.
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
TOTAL:
Prepared by:

VERGIE A. SUASO
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
LOWELL A. AMAZA ( A ) - Absent, not served
School Head (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.
Page 5
 SBFP Form 4 (2020)

SCHOOL-BASED FEEDING PROGRAM

FOR THE MONTH OF DECEMBER- FEBRUARY, SY ___2021-2022__________

Region _______________VII
Division _____________ BOHOL School: ______ DUSITA ELEMENTARY
District ______________ SIERRA BULLONES Grade: ____ KINDER Section
School ID Number: ______ 118682

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
1 ARAGON, ARIES I.
2 MAPANG, SKYLAR LUKE B.
3 AROPO, HONEYLETH SKYE
4 CADELIŇA.MAUMIE C.
5 MAGDAYO,ALLIA JANE M.
6 RETARDO,JANELLE ROSE
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

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

(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
### 102 ### ### ### ### ### ### ### ### ### 112 113 114 115 116 117 118 119 120 (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 VII

REGION/DIVISION/DISTRICT: SIERRA BULLONES

NAME OF SCHOOL: DUSITA
SCHOOL ID NO.: ____________________________________________________________________

SCHOOL-BASED FEEDING PROGRAM - MILK COMPONENT

LIST OF AUTHORIZED CONSIGNEES (SY2021-2022)

NAME & DESIGNATION TEL. NO. MOBILE NO. EMAIL ADD SPECIMEN
SIGNATURE
1
LOWELL A. AMAZA
9566755204 lowell.amaza01@ deped.gov.ph
( School Head)

2
VERGIE A. SUASO
9176189720 vergie.suaso@ deped.gov.ph
(School Feeding Coordinator)

3
VERGIE A. SUASO
9176189720 vergie.suaso@deped.gov.ph
(School Property Custodian)

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 ___

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

SCHOOL-BASED FEEDING PROGRAM - MILK COMPONENT

LIST OF BENEFICIARIES (SY________)

(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

Prepared by: APPROVED BY:

School Feeding Coordinator School Head

 SBFP Form 7 (2020)

DEPARTMENT OF EDUCATION
Region ___

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

SCHOOL-BASED FEEDING PROGRAM - MILK COMPONENT

MILK DELIVERIES (SY________)

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

School Feeding Coordinator School Head

 SBFP Form 7 (2020)

MENT OF EDUCATION
Region ___

NG PROGRAM - MILK COMPONENT

VERIES (SY________)
Remarks
 SBFP Form 7 (2020)

DEPARTMENT OF EDUCATION
Region ___

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

SCHOOL-BASED FEEDING PROGRAM - MILK COMPONENT

MILK DELIVERIES (SY________) FOR DROP-OFF POINTS

Date Delivered No. of Packs Received Allocation per School

New Replacement Total (New + Schools Number of

Replacement) Beneficiries
1 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
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
7
 SBFP Form 7 (2020)

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
2
7 SBFP Form 7 (2020)

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:

School Feeding Coordinator School Head

 SBFP Form 7 (2020)

ENT OF EDUCATION
Region ___

NG PROGRAM - MILK COMPONENT

_______) FOR DROP-OFF POINTS

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

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