Department of Social Welfare and Development

SFP FORM 3_
Field Office MIMAROPA
SUPPLEMENTARY FEEDING PROGRAM
WEIGHT MONITORING REPORT
12th Cycle
Province: Municipality: Barangay:
Name of CDC: Name of CDW:
WEIGHT-FOR-AGE HEIGHT-FOR-AGE WEIGHT-FOR-HEIGHT
Total Number of Children Assessed:
SUW UW N OW SS S N T SW W N OW OB
Based on Boy:
Sex: Girl:
24-35 mos.
Based on 36-47 mos.
Age: 48-59 mos.
60-71 mos.
4Ps:
Based on IPs:
Sector: W/ Disability:
Solo Parent:
Name of Child Sex Birthdate Age in Sector Deworming 1st Vit A Supp. 1st Date of Weighing Weight Height Nutritional Status
No. (B/G) (YYYY/MM/DD) Months (4P/IP/WD/SP) Dose (Date) Dose (Date) (YYYY/MM/DD) in kg in cm REMARKS
First Name M.I. Last Name WFA HFA WFH
1 06/23/2018 B 2018-06-23
2 B 2018-06-20
3 B 2017-12-03
4 B 2018-11-18
5 B 2018-06-14
6 B 2018-12-27
7 B 2019-02-02
8 B 2018-09-11
9 B 2018-07-24
10 B 2018-07-16
11 B 2019-06-14
12 B 2019-09-11
13 B 2018-06-23
14 B 2019-02-05
 15 B 2018-04-27
16 B 2018-08-18
17 G 2018-09-03
18 G 2018-02-12
19 G 2018-05-25
20 G 2018-09-03
21 G 2018-01-04
22 G 2018-06-18
23 G 2019-07-11
24 G 2018-06-14
25 G 2018-11-17
26 G 2018-12-09
27 G 2018-03-16
28 G 2020-04-03
29 G 2017-11-20
30 G 2019-04-05
Page ____ of ____ Date prepared: __________________

Prepared by: ______________________________ Noted by: MA. LOURDES M. FAJARDA, RSW

Child Development Worker/Teacher MSWD Officer
 Department of Social Welfare and Development
SFP FORM 3A
Field Office MIMAROPA
SUPPLEMENTARY FEEDING PROGRAM
WEIGHT MONITORING REPORT
9th Cycle
Province: Municipality: Barangay:
Name of CDC: Name of CDW: UPON ENTRY
Name of Child Sector Date of Nutritional Status
Sex Birthdate Age in Deworming 1st Vit A Supp. 1st Weight Height
No. (B/G) (YYYY/MM/DD) Months
(4P/IP/WD/SP
Dose (Date) Dose (Date)
Weighing
in kg in cm
REMARKS
First Name M.I. Last Name ) (YYYY/MM/DD) WFA HFA WFH
16
17
18
19
20
21
22
23
24
25
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Page ____ of ____ Date prepare__________________

Prepared by: ______________________________ Noted by: ________________________________
Child Development Worker MSWD Officer
 Department of Social Welfare and Development
SFP FORM 3A
Field Office MIMAROPA
SUPPLEMENTARY FEEDING PROGRAM
WEIGHT MONITORING REPORT
9th Cycle
Province: Municipality: Barangay:
Name of CDC: Name of CDW: UPON ENTRY
Name of Child Sector Date of Nutritional Status
Sex Birthdate Age in Deworming 1st Vit A Supp. 1st Weight Height
No. (B/G) (YYYY/MM/DD) Months
(4P/IP/WD/SP
Dose (Date) Dose (Date)
Weighing
in kg in cm
REMARKS
First Name M.I. Last Name ) (YYYY/MM/DD) WFA HFA WFH
36
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Page ____ of ____ Date prepare__________________

Prepared by: ______________________________ Noted by: ________________________________
Child Development Worker MSWD Officer
 Department of Social Welfare and Development
SFP FORM 3A
Field Office MIMAROPA
SUPPLEMENTARY FEEDING PROGRAM
WEIGHT MONITORING REPORT
9th Cycle
Province: Municipality: Barangay:
Name of CDC: Name of CDW: UPON ENTRY
Name of Child Sector Date of Nutritional Status
Sex Birthdate Age in Deworming 1st Vit A Supp. 1st Weight Height
No. (B/G) (YYYY/MM/DD) Months
(4P/IP/WD/SP
Dose (Date) Dose (Date)
Weighing
in kg in cm
REMARKS
First Name M.I. Last Name ) (YYYY/MM/DD) WFA HFA WFH
56
57
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59
60
61
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Page ____ of ____ Date prepare__________________

Prepared by: ______________________________ Noted by: ________________________________
Child Development Worker MSWD Officer
 Department of Social Welfare and Development
SFP FORM 3_
Field Office MIMAROPA
SUPPLEMENTARY FEEDING PROGRAM
WEIGHT MONITORING REPORT
13th Cycle
Province: ROMBLON Municipality: ROMBLON Barangay: LI-O
Name of CDC: LI-O CHILD DEVELOPMENT CENTER Name of CDW: LIANI GEAN T. ESTOPIN AFTER 60 DAYS
WEIGHT-FOR-AGE HEIGHT-FOR-AGE WEIGHT-FOR-HEIGHT
Total Number of Children Assessed: 19
SUW UW N OW SS S N T SW W N OW OB
Based on Boy: 14 0 1 13 0 1 1 12 O 0 0 O 13 1 0
Sex: Girl: 5 0 0 5 0 O 0 5 O 0 0 O 5 0 0
24-35 mos. 0 0 O 0 0 O 0 0 O 0 0 O 0 0 0
Based on 36-47 mos. 4 0 O 4 0 0 0 4 O 0 0 4 0 0
Age: 48-59 mos. 12 0 1 11 0 1 O 11 O 0 0 12 0 0
60-71 mos. 3 0 0 3 0 0 1 2 O 0 0 2 1 0
4Ps: 6 0 1 5 0 1 1 4 O 0 0 6 0 0
Based on IPs: 0 0 0 0 0 0 0 0 O 0 0 0 0 0
Sector: W/ Disability: 0 0 0 0 0 0 0 0 O 0 0 0 0 0
Solo Parent: 1 0 1 0 0 0 0 1 O 0 0 1 0 0
Name of Child Sex Birthdate Age in Sector Deworming 1st Vit A Supp. 1st Date of Weighing Weight Height Nutritional Status
No. (B/G) (YYYY/MM/DD) Months (4P/IP/WD/SP) Dose (Date) Dose (Date) (YYYY/MM/DD) in kg in cm REMARKS
First Name M.I. Last Name WFA HFA WFH
1 ALDRICH M CONSTANTINO B 2019/10/01 51 OCT. 2,2023 2024-03-14 18 104.9 N N N
2 JHOWAN Y LLABORE B 2019/11/19 49 OCT. 2,2023 2024-03-14 14 95.8 N N N
3 CHRIS LANCE R MABUNGA B 2019/08/18 52 4PS OCT. 2,2023 2024-03-14 15.7 103.5 N N N
4 DYLAN RAE B MACHON B 2019/07/05 53 OCT. 2,2023 2024-03-14 16.2 100 N N N
5 FRANCIS M MAGADA B 2019/03/22 57 4PS OCT. 2,2023 2024-03-14 20 112.6 N N N
6 ANDRIE R MANOBO B 2018/11/28 61 OCT. 2,2023 2024-03-14 22 106 N N OW
7 ALBERT MARTOS B 2020/04/21 39 SP OCT. 2,2023 2024-03-14 12.7 93 N N N
8 JOHN GADDIEL M MARTOS B 2020/12/28 36 OCT. 2,2023 2024-03-14 15.3 95.7 N N N NOT BENEFICIARY
9 JAY U M MENORCA B 2019/05/30 55 4PS OCT. 2,2023 2024-03-14 17.3 109.2 N N N
10 JAYVEE R MINDORO B 2020/07/19 41 OCT. 2,2023 2024-03-14 15.2 94.3 N N N
11 SHANE RAPH L MORADA B 2019/08/30 52 OCT. 2,2023 2024-03-14 19 104.6 N N N
12 MARLON M MORENO B 2019/04/12 56 4PS OCT. 2,2023 2024-03-14 12.4 89.8 UW SS N
13 ZIFFORD OWYN ROCERO B 2019/05/22 55 OCT. 2,2023 2024-03-14 15.2 102.4 N N N
14 CALVIN JAMES M ROSANO B 2018/12/13 60 4PS OCT. 2,2023 2024-03-14 14.4 98.2 N S N
15 AYESHA FAITH M DIAZ G 2019/07/29 53 OCT. 2,2023 2024-03-14 14.8 104.3 N N N
16 NIKKI BELLA B FERRERA G 2019/05/31 55 OCT. 2,2023 2024-03-14 15.2 106.3 N N N
 17 KYLIE EVANA M MACHON G 2019/04/23 56 4PS OCT. 2,2023 2024-03-14 13.8 105.5 N N N
18 AALIYA CASSANDRA M MAZO G 2020/10/28 38 OCT. 2,2023 2024-03-14 14 92.5 N N N
19 ASHALEAH SEPHLEEN D MENESE G 2018/11/11 61 OCT. 2,2023 2024-03-14 18.5 110 N N N
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Page ____ of ____ Date prepared: MARCH 14, 2024

Prepared by: LIANI GEAN T. ESTOPIN Noted by: MA. LOURDES M. FAJARDA, RSW
Child Development Worker/Teacher MSWD Officer
 Department of Social Welfare and Development
SFP FORM 3A
Field Office MIMAROPA
SUPPLEMENTARY FEEDING PROGRAM
WEIGHT MONITORING REPORT
13th Cycle
Province: ROMBLON Municipality: ROMBLON Barangay: LI-O
Name of CDC: LI-O CHILD DEVELOPMENT CENTER Name of CDW: LIANI GEAN T. ESTOPIN UPON ENTRY
Name of Child Sector Date of Nutritional Status
Sex Birthdate Age in Deworming 1st Vit A Supp. 1st Weight Height
No. (B/G) (YYYY/MM/DD) Months
(4P/IP/WD/SP
Dose (Date) Dose (Date)
Weighing
in kg in cm
REMARKS
First Name M.I. Last Name ) (YYYY/MM/DD) WFA HFA WFH
1
2
3
4
5
6
7
8
9
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Page ____ of ____ Date prepared: MARCH 14, 2024

Prepared by: LIANI GEAN T. ESTOPIN Noted by: MA. LOURDES M. FAJARDA, RSW
Child Development Worker MSWD Officer
 Department of Social Welfare and Development
SFP FORM 3A
Field Office MIMAROPA
SUPPLEMENTARY FEEDING PROGRAM
WEIGHT MONITORING REPORT
13th Cycle
Province: Municipality: Barangay:
Name of CDC: Name of CDW: UPON ENTRY
Name of Child Sector Date of Nutritional Status
Sex Birthdate Age in Deworming 1st Vit A Supp. 1st Weight Height
No. (B/G) (YYYY/MM/DD) Months
(4P/IP/WD/SP
Dose (Date) Dose (Date)
Weighing
in kg in cm
REMARKS
First Name M.I. Last Name ) (YYYY/MM/DD) WFA HFA WFH
36
37
38
39
40
41
42
43
44
45
46
47
48
49
50
51
52
53
54
55

Page ____ of ____ Date prepared: ___________________

Prepared by: ______________________________ Noted by: MA. LOURDES M. FAJARDA, RSW
Child Development Worker MSWD Officer
 Department of Social Welfare and Development
SFP FORM 3A
Field Office MIMAROPA
SUPPLEMENTARY FEEDING PROGRAM
WEIGHT MONITORING REPORT
13th Cycle
Province: Municipality: Barangay:
Name of CDC: Name of CDW: UPON ENTRY
Name of Child Sector Date of Nutritional Status
Sex Birthdate Age in Deworming 1st Vit A Supp. 1st Weight Height
No. (B/G) (YYYY/MM/DD) Months
(4P/IP/WD/SP
Dose (Date) Dose (Date)
Weighing
in kg in cm
REMARKS
First Name M.I. Last Name ) (YYYY/MM/DD) WFA HFA WFH
56
57
58
59
60
61
62
63
64
65
66
67
68
69
70
71
72
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Page ____ of ____ Date prerared: ______________________________

Prepared by: ______________________________ Noted by: MA. LOURDES M. FAJARDA, RSW
Child Development Worker MSWD Officer
 Department of Social Welfare and Development SFP FORM 1
Field Office MIMAROPA
SUPPLEMENTARY FEEDING PROGRAM
MASTERLIST OF BENEFICIARIES
13th Cycle
TOTAL NUMBER OF CHILDREN:
PROVINCE ROMBLON NAME OF CDC/SNP SITE
MUNICIPALITY ROMBLON ADDRESS BOY GIRL 24-35 M 48-59 M
BARANGAY NAME OF CDW 4P W/ DA 36-47 M 60-71 M
IP SP SUW UW
Name of Child Name of Parent/Guardian
4Ps Solo

Disability
Nutritional Benefi Pare
Sex Birthdate Age in IP
No. First Name MIDDLE NAME Last Name Ext. Name (B/G)
Home Address (YYYY/MM/DD) Months
Status ciary
(Yes/No) (Yes/N
nt
First Name M.I. Last Name
SUW / UW (Yes/
o) No)

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Page ____ of ____

Date prepared:

Prepared by: ___________________________________ Noted by: MA. LOURDES M. FAJARDA, RSW

Child Development Worker/Teacher MSWD Officer