SBFP Form 4

SCHOOL-BASED FEEDING PROGRAM

FOR THE MONTH OF

, SY

Region

VIII

School

Pupua Elementary School

Division

Catbalogan City

Grade

Two

District

Catbalogan IV

2016-2017

Section

OCTOBER

NOVEMBER

ACTUAL
FEEDING

NAME OF PUPIL

6
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5

6
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1. Duena, Justine B.
2. Dueana, Mark Gerald P.
3. Fajardo, hyden Noah B.
4. Quinawayan, Jay Mark B.
5.Roncales, Jaymar T.
6. Tarlac,Christian Raymar O.
7. Criales, Kris Marie P.
8. Balonzo, Sandra C.
9. Cases, Kris Marie P.
10. Dioquino, Mariane M.
11. Duena, Rhea Mae B.
12. Iso, Anica Joy M.
13. Tamayo, Kris Mae T.

D. Actual Feeding
(/) Present, served
(A) Absent, not served
(//) Present, served twice

8
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88

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10
0

SBFP Form 4
SCHOOL-BASED FEEDING PROGRAM
FOR THE MONTH OF

, SY

Region

VIII

School

Pupua Elementary School

Division

Catbalogan City

Grade

Two

District

Catbalogan IV

2016-2017

Section

AUGUST

SEPTEMBER

ACTUAL
FEEDING

NAME OF PUPIL

2
1

2
2

2
3

2
4

2
5

2
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3
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0

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4
8

49

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5
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1. Duena, Justine B.
2. Dueana, Mark Gerald P.
3. Fajardo, hyden Noah B.
4. Quinawayan, Jay Mark B.
5.Roncales, Jaymar T.
6. Tarlac,Christian Raymar O.
7. Criales, Kris Marie P.
8. Balonzo, Sandra C.
9. Cases, Kris Marie P.
10. Dioquino, Mariane M.
11. Duena, Rhea Mae B.
12. Iso, Anica Joy M.
13. Tamayo, Kris Mae T.

D. Actual Feeding
(/) Present, served
(A) Absent, not served
(//) Present, served twice

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SBFP Form 4
SCHOOL-BASED FEEDING PROGRAM
FOR THE MONTH OF

, SY

Region

VIII

School

Pupua Elementary School

Division

Catbalogan City

Grade

Two

District

Catbalogan IV

2016-2017

Section

ACTUAL FEEDING
NAME OF PUPIL

1. Duena, Justine B.
2. Dueana, Mark Gerald P.
3. Fajardo, hyden Noah B.
4. Quinawayan, Jay Mark B.
5.Roncales, Jaymar T.
6. Tarlac,Christian Raymar O.
7. Criales, Kris Marie P.
8. Balonzo, Sandra C.
9. Cases, Kris Marie P.
10. Dioquino, Mariane M.
11. Duena, Rhea Mae B.
12. Iso, Anica Joy M.
13. Tamayo, Kris Mae T.

4Ps
beneficiary
(y or n)

MN
MN
N
Y
N
N
N
N
N
N
N
N
N

Beneficiar
y of
Previous
SBFP (y or
n)

N
N
Y
NN
Y
N
N
N
N
N
N
N
Y

Prepared by:

Feeding Teacher/ School Nurse

Age

Birth
Date

sex

Nutritional Status

DEWORMIN
G

1
Ht
Cm

8.1

8-11-09

7.4

3-26-09

7.4

3-6-09

7.8

11-20-8

8.1

8-29-09

7.2
7.2

12-1308
5-28-09

7.5

2-28-09

7.7

12-1408
04-0109
05-1509
07-2009
09-2909

8.0
7.2
7.0
8.0

M
M
M
M
M
M
F
F
F
F
F
F
F

Wt
Kg

Dat
e
Take
n

N
S

(/)
OR
(X)

Dat
e
Take
n

1
0

1
1

1
2

1
3

1
4

1
5

1
6

1
7

1
8

1
9

20

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LEGEND
TOTAL:
A. Nutritional
Status
For 6-19 y.o
For Below 6 y.o
B. Deworming
SUSeverely
SW- Severely
(x) not dewormed
Underweight
Wasted
(/) - dewormed
U- Underweight
W- Wasted
N- Normal
N- Normal
Ow- Overweight
Ow- Overweight
O- Obese

D. Actual Feeding
(/) Present, Serve
(A) Absent, not Served
(//)- Present, Serve Twice