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Masterlist Classroom Nutritional Status With Computation

The document appears to be a form for collecting nutritional status data on students. It includes fields for student name, birthdate, age in months, height, weight, BMI, and nutritional status. The form collects this data for 60 students.
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© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
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Download as DOC, PDF, TXT or read online on Scribd
0% found this document useful (0 votes)
22 views

Masterlist Classroom Nutritional Status With Computation

The document appears to be a form for collecting nutritional status data on students. It includes fields for student name, birthdate, age in months, height, weight, BMI, and nutritional status. The form collects this data for 60 students.
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as DOC, PDF, TXT or read online on Scribd
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NUTRITIONAL STATUS Baseline: [ ] Endline: [ ] SY: 20___- - 20___

SCHOOL:______________________ DISTRICT:_______________ Grade LEVEL: ______ Section:_________________


Age in Raw Ht. Div. Ht. Raw Nut. Ht.
Birthday mos. Ht./cm. 100 cm. in m2 Wt./kgs. BMI Status Status

1. ________________ _______ _____ ______ _____ ______ ______ ______ _____ _____
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59.________________ _______ _____ ______ _____ ______ ______ ______ _____ _____
60.________________ _______ _____ ______ _____ ______ ______ ______ _____ _____
Prepared by:
_______________________
Class Adviser
4 Ps NUTRITIONAL STATUS Baseline: [ ] Endline: [ ] SY: 20___- - 20___

SCHOOL:______________________ DISTRICT:_______________ Grade LEVEL: ______ Section:_________________


Age in Raw Ht. Div. Ht. Raw Nut. Ht.
Birthday mos. Ht./cm. 100 cm. in m2 Wt./kgs. BMI Status Status

1. ________________ _______ _____ ______ _____ ______ ______ ______ _____ _____
2. ________________ _______ _____ ______ _____ ______ ______ ______ _____ _____
3. ________________ _______ _____ ______ _____ ______ ______ ______ _____ _____
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10.________________ _______ _____ ______ _____ ______ ______ ______ _____ _____
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58.________________ _______ _____ ______ _____ ______ ______ ______ _____ _____
59.________________ _______ _____ ______ _____ ______ ______ ______ _____ _____
60.________________ _______ _____ ______ _____ ______ ______ ______ _____ _____
Prepared by:
_______________________
Class Adviser
PWD NUTRITIONAL STATUS Baseline: [ ] Endline: [ ] SY: 20___- - 20___

SCHOOL:______________________ DISTRICT:_______________ Grade LEVEL: ______ Section:_________________


Age in Raw Ht. Div. Ht. Raw Nut. Ht.
Birthday mos. Ht./cm. 100 cm. in m2 Wt./kgs. BMI Status Status

1. ________________ _______ _____ ______ _____ ______ ______ ______ _____ _____
2. ________________ _______ _____ ______ _____ ______ ______ ______ _____ _____
3. ________________ _______ _____ ______ _____ ______ ______ ______ _____ _____
4. ________________ _______ _____ ______ _____ ______ ______ ______ _____ _____
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57.________________ _______ _____ ______ _____ ______ ______ ______ _____ _____
58.________________ _______ _____ ______ _____ ______ ______ ______ _____ _____
59.________________ _______ _____ ______ _____ ______ ______ ______ _____ _____
60.________________ _______ _____ ______ _____ ______ ______ ______ _____ _____
Prepared by:
_______________________
Class Adviser
NUTRITIONAL STATUS Baseline: [ ] Endline: [ ] SY: 20___- 20___
SCHOOL:______________________ DISTRICT:________________ GRADE Level: ______ Section:___________
Age in Raw Ht. Div. Ht. Raw Nut. Ht.
BOYS: Birthday mos. Ht./cm. 100 cm. in m2 Wt./kgs. BMI Status Stat.

1. ____________________ _______ _____ ______ _____ ______ ______ ______ _____ ____
2. ____________________ _______ _____ ______ _____ ______ ______ ______ _____ ____
3. ____________________ _______ _____ ______ _____ ______ ______ ______ _____ ____
4. ____________________ _______ _____ ______ _____ ______ ______ ______ _____ ____
5. ____________________ _______ _____ ______ _____ ______ ______ ______ _____ ____
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9. ____________________ _______ _____ ______ _____ ______ ______ ______ _____ ____
10. ___________________ _______ _____ ______ _____ ______ ______ ______ _____ ____
11. ___________________ _______ _____ ______ _____ ______ ______ ______ _____ ____
12. ___________________ _______ _____ ______ _____ ______ ______ ______ _____ ____
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29. ___________________ _______ _____ ______ _____ ______ ______ ______ _____ ____
30. ___________________ _______ _____ ______ _____ ______ ______ ______ _____ ____
GIRLS:
1. ____________________ _______ _____ ______ _____ ______ ______ ______ _____ ____
2. ____________________ _______ _____ ______ _____ ______ ______ ______ _____ ____
3. ____________________ _______ _____ ______ _____ ______ ______ ______ _____ ____
4. ____________________ _______ _____ ______ _____ ______ ______ ______ _____ ____
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21. ___________________ _______ _____ ______ _____ ______ ______ ______ _____ ____
22. ___________________ _______ _____ ______ _____ ______ ______ ______ _____ ____
23. ___________________ _______ _____ ______ _____ ______ ______ ______ _____ ____
24. ___________________ _______ _____ ______ _____ ______ ______ ______ _____ ____
25. ____________________ _______ _____ ______ _____ ______ ______ ______ _____ ____
26. ____________________ _______ _____ ______ _____ ______ ______ ______ _____ ____
27. ____________________ _______ _____ ______ _____ ______ ______ ______ _____ ____
28. ____________________ _______ _____ ______ _____ ______ ______ ______ _____ ____
29. ____________________ _______ _____ ______ _____ ______ ______ ______ _____ ____
30. ____________________ _______ _____ ______ _____ ______ ______ ______ _____ ____
Prepared by:
_______________________
Class Adviser
4 Ps
NUTRITIONAL STATUS Baseline: [ ] Endline: [ ] SY: 20___- 20___
SCHOOL:______________________ DISTRICT:_____________ GRADE/YEAR Level: ______ Section:___________
Age in Raw Ht. Div. Ht. Raw Nut. Ht.
BOYS: Birthday mos. Ht./cm. 100 cm. in m2 Wt./kgs. BMI Status Stat.

1. ____________________ _______ _____ ______ _____ ______ ______ ______ _____ ____
2. ____________________ _______ _____ ______ _____ ______ ______ ______ _____ ____
3. ____________________ _______ _____ ______ _____ ______ ______ ______ _____ ____
4. ____________________ _______ _____ ______ _____ ______ ______ ______ _____ ____
5. ____________________ _______ _____ ______ _____ ______ ______ ______ _____ ____
6. ____________________ _______ _____ ______ _____ ______ ______ ______ _____ ____
7. ____________________ _______ _____ ______ _____ ______ ______ ______ _____ ____
8. ____________________ _______ _____ ______ _____ ______ ______ ______ _____ ____
9. ____________________ _______ _____ ______ _____ ______ ______ ______ _____ ____
10. ___________________ _______ _____ ______ _____ ______ ______ ______ _____ ____
11. ___________________ _______ _____ ______ _____ ______ ______ ______ _____ ____
12. ___________________ _______ _____ ______ _____ ______ ______ ______ _____ ____
13. ___________________ _______ _____ ______ _____ ______ ______ ______ _____ ____
14. ___________________ _______ _____ ______ _____ ______ ______ ______ _____ ____
15. ___________________ _______ _____ ______ _____ ______ ______ ______ _____ ____
16. ___________________ _______ _____ ______ _____ ______ ______ ______ _____ ____
17. ___________________ _______ _____ ______ _____ ______ ______ ______ _____ ____
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19. ___________________ _______ _____ ______ _____ ______ ______ ______ _____ ____
20. ___________________ _______ _____ ______ _____ ______ ______ ______ _____ ____
21. ___________________ _______ _____ ______ _____ ______ ______ ______ _____ ____
22. ___________________ _______ _____ ______ _____ ______ ______ ______ _____ ____
23. ___________________ _______ _____ ______ _____ ______ ______ ______ _____ ____
24. ___________________ _______ _____ ______ _____ ______ ______ ______ _____ ____
25. ___________________ _______ _____ ______ _____ ______ ______ ______ _____ ____
26. ___________________ _______ _____ ______ _____ ______ ______ ______ _____ ____
27. ___________________ _______ _____ ______ _____ ______ ______ ______ _____ ____
28. ___________________ _______ _____ ______ _____ ______ ______ ______ _____ ____
29. ___________________ _______ _____ ______ _____ ______ ______ ______ _____ ____
30. ___________________ _______ _____ ______ _____ ______ ______ ______ _____ ____
GIRLS:
1. ____________________ _______ _____ ______ _____ ______ ______ ______ _____ ____
2. ____________________ _______ _____ ______ _____ ______ ______ ______ _____ ____
3. ____________________ _______ _____ ______ _____ ______ ______ ______ _____ ____
4. ____________________ _______ _____ ______ _____ ______ ______ ______ _____ ____
5. ____________________ _______ _____ ______ _____ ______ ______ ______ _____ ____
6. ____________________ _______ _____ ______ _____ ______ ______ ______ _____ ____
7. ____________________ _______ _____ ______ _____ ______ ______ ______ _____ ____
8. ____________________ _______ _____ ______ _____ ______ ______ ______ _____ ____
9. ____________________ _______ _____ ______ _____ ______ ______ ______ _____ ____
10. ___________________ _______ _____ ______ _____ ______ ______ ______ _____ ____
11. ___________________ _______ _____ ______ _____ ______ ______ ______ _____ ____
12. ___________________ _______ _____ ______ _____ ______ ______ ______ _____ ____
13. ___________________ _______ _____ ______ _____ ______ ______ ______ _____ ____
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15. ___________________ _______ _____ ______ _____ ______ ______ ______ _____ ____
16. ___________________ _______ _____ ______ _____ ______ ______ ______ _____ ____
17. ___________________ _______ _____ ______ _____ ______ ______ ______ _____ ____
18. ___________________ _______ _____ ______ _____ ______ ______ ______ _____ ____
19. ___________________ _______ _____ ______ _____ ______ ______ ______ _____ ____
20. ___________________ _______ _____ ______ _____ ______ ______ ______ _____ ____
21. ___________________ _______ _____ ______ _____ ______ ______ ______ _____ ____
22. ___________________ _______ _____ ______ _____ ______ ______ ______ _____ ____
23. ___________________ _______ _____ ______ _____ ______ ______ ______ _____ ____
24. ___________________ _______ _____ ______ _____ ______ ______ ______ _____ ____
25. ____________________ _______ _____ ______ _____ ______ ______ ______ _____ ____
26. ____________________ _______ _____ ______ _____ ______ ______ ______ _____ ____
27. ____________________ _______ _____ ______ _____ ______ ______ ______ _____ ____
28. ____________________ _______ _____ ______ _____ ______ ______ ______ _____ ____
29. ____________________ _______ _____ ______ _____ ______ ______ ______ _____ ____
30. ____________________ _______ _____ ______ _____ ______ ______ ______ _____ ____
Prepared by:
_______________________
Class Adviser
PWD
NUTRITIONAL STATUS Baseline: [ ] Endline: [ ] SY: 20___- 20___
SCHOOL:______________________ DISTRICT:_____________ GRADE/YEAR Level: ______ Section:___________
Age in Raw Ht. Div. Ht. Raw Nut. Ht.
BOYS: Birthday mos. Ht./cm. 100 cm. in m2 Wt./kgs. BMI Status Stat.

1. ____________________ _______ _____ ______ _____ ______ ______ ______ _____ ____
2. ____________________ _______ _____ ______ _____ ______ ______ ______ _____ ____
3. ____________________ _______ _____ ______ _____ ______ ______ ______ _____ ____
4. ____________________ _______ _____ ______ _____ ______ ______ ______ _____ ____
5. ____________________ _______ _____ ______ _____ ______ ______ ______ _____ ____
6. ____________________ _______ _____ ______ _____ ______ ______ ______ _____ ____
7. ____________________ _______ _____ ______ _____ ______ ______ ______ _____ ____
8. ____________________ _______ _____ ______ _____ ______ ______ ______ _____ ____
9. ____________________ _______ _____ ______ _____ ______ ______ ______ _____ ____
10. ___________________ _______ _____ ______ _____ ______ ______ ______ _____ ____
11. ___________________ _______ _____ ______ _____ ______ ______ ______ _____ ____
12. ___________________ _______ _____ ______ _____ ______ ______ ______ _____ ____
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16. ___________________ _______ _____ ______ _____ ______ ______ ______ _____ ____
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23. ___________________ _______ _____ ______ _____ ______ ______ ______ _____ ____
24. ___________________ _______ _____ ______ _____ ______ ______ ______ _____ ____
25. ___________________ _______ _____ ______ _____ ______ ______ ______ _____ ____
26. ___________________ _______ _____ ______ _____ ______ ______ ______ _____ ____
27. ___________________ _______ _____ ______ _____ ______ ______ ______ _____ ____
28. ___________________ _______ _____ ______ _____ ______ ______ ______ _____ ____
29. ___________________ _______ _____ ______ _____ ______ ______ ______ _____ ____
30. ___________________ _______ _____ ______ _____ ______ ______ ______ _____ ____
GIRLS:
1. ____________________ _______ _____ ______ _____ ______ ______ ______ _____ ____
2. ____________________ _______ _____ ______ _____ ______ ______ ______ _____ ____
3. ____________________ _______ _____ ______ _____ ______ ______ ______ _____ ____
4. ____________________ _______ _____ ______ _____ ______ ______ ______ _____ ____
5. ____________________ _______ _____ ______ _____ ______ ______ ______ _____ ____
6. ____________________ _______ _____ ______ _____ ______ ______ ______ _____ ____
7. ____________________ _______ _____ ______ _____ ______ ______ ______ _____ ____
8. ____________________ _______ _____ ______ _____ ______ ______ ______ _____ ____
9. ____________________ _______ _____ ______ _____ ______ ______ ______ _____ ____
10. ___________________ _______ _____ ______ _____ ______ ______ ______ _____ ____
11. ___________________ _______ _____ ______ _____ ______ ______ ______ _____ ____
12. ___________________ _______ _____ ______ _____ ______ ______ ______ _____ ____
13. ___________________ _______ _____ ______ _____ ______ ______ ______ _____ ____
14. ___________________ _______ _____ ______ _____ ______ ______ ______ _____ ____
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16. ___________________ _______ _____ ______ _____ ______ ______ ______ _____ ____
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18. ___________________ _______ _____ ______ _____ ______ ______ ______ _____ ____
19. ___________________ _______ _____ ______ _____ ______ ______ ______ _____ ____
20. ___________________ _______ _____ ______ _____ ______ ______ ______ _____ ____
21. ___________________ _______ _____ ______ _____ ______ ______ ______ _____ ____
22. ___________________ _______ _____ ______ _____ ______ ______ ______ _____ ____
23. ___________________ _______ _____ ______ _____ ______ ______ ______ _____ ____
24. ___________________ _______ _____ ______ _____ ______ ______ ______ _____ ____
25. ____________________ _______ _____ ______ _____ ______ ______ ______ _____ ____
26. ____________________ _______ _____ ______ _____ ______ ______ ______ _____ ____
27. ____________________ _______ _____ ______ _____ ______ ______ ______ _____ ____
28. ____________________ _______ _____ ______ _____ ______ ______ ______ _____ ____
29. ____________________ _______ _____ ______ _____ ______ ______ ______ _____ ____
30. ____________________ _______ _____ ______ _____ ______ ______ ______ _____ ____
Prepared by:
_______________________
Class Adviser
NUTRITIONAL STATUS: ( ) Baseline ( ) Endline SY: 20____ - 20____
School:__________________ District:______________ Grade:_____ Section:______________
Enrolment: No.: Male:______ Female:______

BOYS:

1._________________________
Ht.S NS
Yy mm dd _____cm. div.by 100= ____ m. _____ BMI=_____kgs.
X ____ ______m2
DW: Ht. =________m2 BMI= ________ ____
- DB : _________________________ or _______
____ yrs. ____mos. ____days
____ X 12 = _____mo.+ ____mo.= ______ mos.

2._________________________
Ht.S NS
DW: _____cm. div.by 100=____ m. _____ BMI= _____kgs.
- DB: __________________________ X____ ______m2
____yrs. ____mos. ____days Ht. = _______ m2 BMI= _______ ____
____ X 12 = _____mo.+ ____mo. = ______mos. or_______

3._________________________
Ht.S NS
DW: _____cm. div.by 100= _____ m. _____ BMI= _____kgs.
-BD : ___________________________ X_____ ______m2
____yrs. ____mos. _____days Ht. = ______m2 BMI= _______ ____
____ X 12 = ____mo. + ____mo. = ______mos. or ______

4._________________________
Ht.S NS
DW: _____cm. div.by 100= _____ m. _____ BMI= _____kgs.
- DB: ___________________________ X_____ ______m2
____yrs. ____mos. _____days Ht. = ______m2 BMI= _______ ____
____ X 12= _____mo. + ___mos. = ______mos. or ______

5._________________________
Ht.S NS
DW: _____cm div.by 100= _____ m. _____ BMI= _____kgs.
-DB: ____________________________ X_____ ______m2
____yrs. ____mos. _____days Ht. = ______m2 BMI= _______ ____
____X 12 =_____mo. + ____mos.= ______mos. or______

6._________________________
Ht.S NS
DW : _____cm. div.by 100=_____ m. _____ BMI=______kgs.
-DB : _____________________________ X_____ ______m2
_____yrs. ____mos. _____days Ht. = ______m2 BMI= _______ ____
____ X 12 = _____mo. + ____mos.= _____mos. or ______

7._________________________
Ht.S NS
DW : _____cm.div.by 100= _____ m. _____ BMI=_____kgs.
-DB : ____________________________ X_____ ______m2
_____yrs. ____mos. _____days Ht. = ______m2 BMI=______ ____
____X 12= _____mo. + ____mos.= ______mos. or______

8._________________________
Ht.S NS
DW: _____cm. div.by 100= ____ m. _____ BMI=_____ kgs.
-DB : ____________________________ X_____ ______m2
____yrs. ____mos. _____days Ht. = ______m2 BMI=_______ ____
____ X 12 = _____mo. + ____mos. = ____mos. or______
9._________________________
Ht.S NS
DW: _____cm. div.by 100=_____ m. _____ BMI= _____kgs.
- DB: __________________________ X_____ ______m2
____yrs. ____mos. ____days Ht. = ______ m2 BMI= ______ ____
____X 12 = _____mo.+ ____mo. = ______mos. or_______

10.________________________
Ht.S NS
DW: _____cm. div.by 100=_____ m. _____ BMI= ______kgs.
-DB: __________________________ X_____ _______m2
____yrs. ____mos. ____days Ht.= ______m2 BMI= ______ ____
____X 12=_____mo.+ ____mo. = _______mos. or_______

11,_______________________ Ht.S NS
_____cm. div.by 100= ____ m. _____ BMI=_____kgs.
X ____ ______m2
DW: Ht. =________m2 BMI= ________ ____
- DB : _________________________ or _______
____ yrs. ____mos. ____days
____ X 12 = _____mo.+ ____mo.= ______ mos.

12._______________________
Ht.S NS
DW: _____cm. div.by 100=____ m. _____ BMI= _____kgs.
- DB: __________________________ X____ ______m2
____yrs. ____mos. ____days Ht. = _______ m2 BMI= _______ ____
____ X 12 = _____mo.+ ____mo. = ______mos. or_______

13._______________________
Ht.S NS
DW: _____cm. div.by 100= _____ m. _____ BMI= _____kgs.
-BD : ___________________________ X_____ ______m2
____yrs. ____mos. _____days Ht. = ______m2 BMI= _______ ____
____ X 12 = ____mo. + ____mo. = ______mos. or ______

14._______________________
Ht.S NS
DW: _____cm. div.by 100= _____ m. _____ BMI= _____kgs.
- DB: ___________________________ X_____ ______m2
____yrs. ____mos. _____days Ht. = ______m2 BMI= _______ ____
____ X 12= _____mo. + ___mos. = ______mos. or ______

15._______________________
Ht.S NS
DW: _____cm div.by 100= _____ m. _____ BMI= _____kgs.
-DB: ____________________________ X_____ ______m2
____yrs. ____mos. _____days Ht. = ______m2 BMI= _______ ____
____X 12 =_____mo. + ____mos.= ______mos. or______

16._______________________
Ht.S NS
DW : _____cm. div.by 100=_____ m. _____ BMI=______kgs.
-DB : _____________________________ X_____ ______m2
_____yrs. ____mos. _____days Ht. = ______m2 BMI= _______ ____
____ X 12 = _____mo. + ____mos.= _____mos. or ______

17._______________________
Ht.S NS
DW : _____cm.div.by 100= _____ m. _____ BMI=_____kgs.
-DB : ____________________________ X_____ ______m2
_____yrs. ____mos. _____days Ht. = ______m2 BMI=______ ____
____X 12= _____mo. + ____mos.= ______mos. or______
18.._________________________
Ht.S NS
DW: _____cm. div.by 100=_____ m. _____ BMI= _____kgs.
- DB: __________________________ X_____ ______m2
____yrs. ____mos. ____days Ht. = ______ m2 BMI= ______ ____
____X 12 = _____mo.+ ____mo. = ______mos. or_______

19.________________________
Ht.S NS
DW: _____cm. div.by 100=_____ m. _____ BMI= ______kgs.
-DB: __________________________ X_____ _______m2
____yrs. ____mos. ____days Ht.= ______m2 BMI= ______ ____
____X 12=_____mo.+ ____mo. = _______mos. or_______

20,_______________________ Ht.S NS
_____cm. div.by 100= ____ m. _____ BMI=_____kgs.
X ____ ______m2
DW: Ht. =________m2 BMI= ________ ____
- DB : _________________________ or _______
____ yrs. ____mos. ____days
____ X 12 = _____mo.+ ____mo.= ______ mos.

21._______________________
Ht.S NS
DW: _____cm. div.by 100=____ m. _____ BMI= _____kgs.
- DB: __________________________ X____ ______m2
____yrs. ____mos. ____days Ht. = _______ m2 BMI= _______ ____
____ X 12 = _____mo.+ ____mo. = ______mos. or_______

22._______________________
Ht.S NS
DW: _____cm. div.by 100= _____ m. _____ BMI= _____kgs.
-BD : ___________________________ X_____ ______m2
____yrs. ____mos. _____days Ht. = ______m2 BMI= _______ ____
____ X 12 = ____mo. + ____mo. = ______mos. or ______

23._______________________
Ht.S NS
DW: _____cm. div.by 100= _____ m. _____ BMI= _____kgs.
- DB: ___________________________ X_____ ______m2
____yrs. ____mos. _____days Ht. = ______m2 BMI= _______ ____
____ X 12= _____mo. + ___mos. = ______mos. or ______

24._______________________
Ht.S NS
DW: _____cm div.by 100= _____ m. _____ BMI= _____kgs.
-DB: ____________________________ X_____ ______m2
____yrs. ____mos. _____days Ht. = ______m2 BMI= _______ ____
____X 12 =_____mo. + ____mos.= ______mos. or______

25._______________________
Ht.S NS
DW : _____cm. div.by 100=_____ m. _____ BMI=______kgs.
-DB : _____________________________ X_____ ______m2
_____yrs. ____mos. _____days Ht. = ______m2 BMI= _______ ____
____ X 12 = _____mo. + ____mos.= _____mos. or ______

26._______________________
Ht.S NS
DW : _____cm.div.by 100= _____ m. _____ BMI=_____kgs.
-DB : ____________________________ X_____ ______m2
_____yrs. ____mos. _____days Ht. = ______m2 BMI=______ ____
____X 12= _____mo. + ____mos.= ______mos. or______
27._________________________
Ht.S NS
DW: _____cm. div.by 100=_____ m. _____ BMI= _____kgs.
- DB: __________________________ X_____ ______m2
____yrs. ____mos. ____days Ht. = ______ m2 BMI= ______ ____
____X 12 = _____mo.+ ____mo. = ______mos. or_______

28.________________________
Ht.S NS
DW: _____cm. div.by 100=_____ m. _____ BMI= ______kgs.
-DB: __________________________ X_____ _______m2
____yrs. ____mos. ____days Ht.= ______m2 BMI= ______ ____
____X 12=_____mo.+ ____mo. = _______mos. or_______

29,_______________________ Ht.S NS
_____cm. div.by 100= ____ m. _____ BMI=_____kgs.
X ____ ______m2
DW: Ht. =________m2 BMI= ________ ____
- DB : _________________________ or _______
____ yrs. ____mos. ____days
____ X 12 = _____mo.+ ____mo.= ______ mos.

30._______________________
Ht.S NS
DW: _____cm. div.by 100=____ m. _____ BMI= _____kgs.
- DB: __________________________ X____ ______m2
____yrs. ____mos. ____days Ht. = _______ m2 BMI= _______ ____
____ X 12 = _____mo.+ ____mo. = ______mos. or_______

31._______________________
Ht.S NS
DW: _____cm. div.by 100= _____ m. _____ BMI= _____kgs.
-BD : ___________________________ X_____ ______m2
____yrs. ____mos. _____days Ht. = ______m2 BMI= _______ ____
____ X 12 = ____mo. + ____mo. = ______mos. or ______

32._______________________
Ht.S NS
DW: _____cm. div.by 100= _____ m. _____ BMI= _____kgs.
- DB: ___________________________ X_____ ______m2
____yrs. ____mos. _____days Ht. = ______m2 BMI= _______ ____
____ X 12= _____mo. + ___mos. = ______mos. or ______

33._______________________
Ht.S NS
DW: _____cm div.by 100= _____ m. _____ BMI= _____kgs.
-DB: ____________________________ X_____ ______m2
____yrs. ____mos. _____days Ht. = ______m2 BMI= _______ ____
____X 12 =_____mo. + ____mos.= ______mos. or______

34._______________________
Ht.S NS
DW : _____cm. div.by 100=_____ m. _____ BMI=______kgs.
-DB : _____________________________ X_____ ______m2
_____yrs. ____mos. _____days Ht. = ______m2 BMI= _______ ____
____ X 12 = _____mo. + ____mos.= _____mos. or ______

35._______________________
Ht.S NS
DW : _____cm.div.by 100= _____ m. _____ BMI=_____kgs.
-DB : ____________________________ X_____ ______m2
_____yrs. ____mos. _____days Ht. = ______m2 BMI=______ ____
____X 12= _____mo. + ____mos.= ______mos. or______
NUTRITIONAL STATUS: ( ) Baseline ( ) Endline SY: 20____ - 20____
School:__________________ District:______________ Grade:_____ Section:______________
Enrolment: No.: Male:______ Female:______

GIRLS:

1._________________________
Ht.S NS
Yy mm dd _____cm. div.by 100= ____ m. _____ BMI=_____kgs.
X ____ ______m2
DW: Ht. =________m2 BMI= ________ ____
- DB : _________________________ or _______
____ yrs. ____mos. ____days
____ X 12 = _____mo.+ ____mo.= ______ mos.

2._________________________
Ht.S NS
DW: _____cm. div.by 100=____ m. _____ BMI= _____kgs.
- DB: __________________________ X____ ______m2
____yrs. ____mos. ____days Ht. = _______ m2 BMI= _______ ____
____ X 12 = _____mo.+ ____mo. = ______mos. or_______

3._________________________
Ht.S NS
DW: _____cm. div.by 100= _____ m. _____ BMI= _____kgs.
-BD : ___________________________ X_____ ______m2
____yrs. ____mos. _____days Ht. = ______m2 BMI= _______ ____
____ X 12 = ____mo. + ____mo. = ______mos. or ______

4._________________________
Ht.S NS
DW: _____cm. div.by 100= _____ m. _____ BMI= _____kgs.
- DB: ___________________________ X_____ ______m2
____yrs. ____mos. _____days Ht. = ______m2 BMI= _______ ____
____ X 12= _____mo. + ___mos. = ______mos. or ______

5._________________________
Ht.S NS
DW: _____cm div.by 100= _____ m. _____ BMI= _____kgs.
-DB: ____________________________ X_____ ______m2
____yrs. ____mos. _____days Ht. = ______m2 BMI= _______ ____
____X 12 =_____mo. + ____mos.= ______mos. or______

6._________________________
Ht.S NS
DW : _____cm. div.by 100=_____ m. _____ BMI=______kgs.
-DB : _____________________________ X_____ ______m2
_____yrs. ____mos. _____days Ht. = ______m2 BMI= _______ ____
____ X 12 = _____mo. + ____mos.= _____mos. or ______

7._________________________
Ht.S NS
DW : _____cm.div.by 100= _____ m. _____ BMI=_____kgs.
-DB : ____________________________ X_____ ______m2
_____yrs. ____mos. _____days Ht. = ______m2 BMI=______ ____
____X 12= _____mo. + ____mos.= ______mos. or______

8._________________________
Ht.S NS
DW: _____cm. div.by 100= ____ m. _____ BMI=_____ kgs.
-DB : ____________________________ X_____ ______m2
____yrs. ____mos. _____days Ht. = ______m2 BMI=_______ ____
____ X 12 = _____mo. + ____mos. = ____mos. or______
9._________________________
Ht.S NS
DW: _____cm. div.by 100=_____ m. _____ BMI= _____kgs.
- DB: __________________________ X_____ ______m2
____yrs. ____mos. ____days Ht. = ______ m2 BMI= ______ ____
____X 12 = _____mo.+ ____mo. = ______mos. or_______

10.________________________
Ht.S NS
DW: _____cm. div.by 100=_____ m. _____ BMI= ______kgs.
-DB: __________________________ X_____ _______m2
____yrs. ____mos. ____days Ht.= ______m2 BMI= ______ ____
____X 12=_____mo.+ ____mo. = _______mos. or_______

11,_______________________ Ht.S NS
_____cm. div.by 100= ____ m. _____ BMI=_____kgs.
X ____ ______m2
DW: Ht. =________m2 BMI= ________ ____
- DB : _________________________ or _______
____ yrs. ____mos. ____days
____ X 12 = _____mo.+ ____mo.= ______ mos.

12._______________________
Ht.S NS
DW: _____cm. div.by 100=____ m. _____ BMI= _____kgs.
- DB: __________________________ X____ ______m2
____yrs. ____mos. ____days Ht. = _______ m2 BMI= _______ ____
____ X 12 = _____mo.+ ____mo. = ______mos. or_______

13._______________________
Ht.S NS
DW: _____cm. div.by 100= _____ m. _____ BMI= _____kgs.
-BD : ___________________________ X_____ ______m2
____yrs. ____mos. _____days Ht. = ______m2 BMI= _______ ____
____ X 12 = ____mo. + ____mo. = ______mos. or ______

14._______________________
Ht.S NS
DW: _____cm. div.by 100= _____ m. _____ BMI= _____kgs.
- DB: ___________________________ X_____ ______m2
____yrs. ____mos. _____days Ht. = ______m2 BMI= _______ ____
____ X 12= _____mo. + ___mos. = ______mos. or ______

15._______________________
Ht.S NS
DW: _____cm div.by 100= _____ m. _____ BMI= _____kgs.
-DB: ____________________________ X_____ ______m2
____yrs. ____mos. _____days Ht. = ______m2 BMI= _______ ____
____X 12 =_____mo. + ____mos.= ______mos. or______

16._______________________
Ht.S NS
DW : _____cm. div.by 100=_____ m. _____ BMI=______kgs.
-DB : _____________________________ X_____ ______m2
_____yrs. ____mos. _____days Ht. = ______m2 BMI= _______ ____
____ X 12 = _____mo. + ____mos.= _____mos. or ______

17._______________________
Ht.S NS
DW : _____cm.div.by 100= _____ m. _____ BMI=_____kgs.
-DB : ____________________________ X_____ ______m2
_____yrs. ____mos. _____days Ht. = ______m2 BMI=______ ____
____X 12= _____mo. + ____mos.= ______mos. or______

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