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SBFB Form 3

Department of Education
Region ____

SCHOOL-BASED FEEDING PROGRAM (SBFP)

Division/Province: _________________________
School District/City/ Muncipality: ___________________

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

Prepared by: Noted by:


______________________ __________________________
SBFP DepED Focal Unit Chief

Note: This form shall be prepared by the DO, for final consolidation by the RO, for submission to DSWD-FO, copy furnished DepED-HNC
SBFP Form 2

Department of Education
Region ______

SCHOOL-BASED FEEDING PROGRAM (SBFP)

Division/Province: ______________________________
City/Municipality/Barangay: ______________________
Name of School/School District: ___________________
Nutritional Status at Start of Feeding Ethnicity 4 Ps Beneficiaries
Number of
Undernourished School No. of No. of Total No. of Pupils who are
Children by Grade Level Severely Wasted Beneficiaries No. of Ethnic No. of 4 Ps Ben. beneficiaries in
Wasted Ben. previous years Remarks
1. Kinder

2. Grade I

3. Grade II

4. Grade III

5. Grade IV

Grade V

Grade VI

Total

Prepared by: Noted by:

__________________________________ ___________________________
SBFP DepED Focal Unif Chief

Note: This form shall be prepared by the school, to be compiled by the DO, and for final compilation by the RO, for submission to DSWD-FO, copy furnished
DepED-HNC
SBFP Form 1

Department of Education
Region _____

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

Division/Province: ____________________ Name of Principal: ______________________


City/Municipality/Barangay: _______________ Name of Feeding Focal Person: ____________
BMI for Name Beneficiary
Date of Birth Date of Wei Heig 6 y.o.
No. Name Sex Age in Nutritional Ethnicity Disability 4Ps ID of of SBFP in
(MM/DD/YYY) Weighing/ ght ht
Measuring Years/ and Status Number Parents Previous
(Kg) (cm)
(MM/DD/YYY) Months above (NS) Years

Prepared by: Noted:

________________________ ____________________________
Feeding Focal Person School Principal/Officer-in-Charge

Note: This form shall be prepared by the school, to be compiled by the DO, and for final compilation by the RO, for submission to DSWD, copy furnished
DepED-HNC

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