Revised 07/08

OFFICE OF POLICY AND MANAGEMENT

CRIMINAL JUSTICE POLICY AND PLANNING DIVISION

Final Report: Submit by U.S. mail

All other reports: Submit by email to

PROGRESS REPORT: Title V Delinquency Prevention Program

Identification

A.Grantee:

B.OPM Grant Number:

C.Project Title:

D.Implementing Agency:

(if different from Grantee)

  1. Period of Award: to
  1. Report Type:

Quarterly

Final

Interim

  1. Report for the Period Ending: (A Separate Report is REQUIRED for Each Period)

September 30 (Report Due: October 15)

December 31 (Report Due: January 15)

March 31 (Report Due: April 15)

June 30 (Report Due: July 15)

Other (specify report period):

Please explain:

  1. Year:

Certification

Your typed name, in lieu of your signature, certifies that the information contained in this report is based on official records and is, to the best of your knowledge and belief, true and correct. Signature is required for FINAL reports.

Report Prepared by:Date (m/d/yyyy):

Typed Name or Signature

Telephone: E-mail Address:

SummaryInformation

Please summarize activities for the quarter. Include any special events, staff changes, and new program approaches. Limit your response to onehalfpage. DO NOT append copies of flyers, etc.

Project Criteria

Please complete thissection for the first reporting period only.

List the criteria youth must meet to successfully complete the project. For example, list the number of sessions, number/type of activities, community service project(s), and/or leadership development opportunities in which youth would have to participate to successfully complete the project.

Data

Please answer each question. Do not leave any items blank or enter “not applicable.” If you do not have data for a particular item, enter “0.”

A.Number of Youth Served (Unduplicated Count)

1.Number of youth carried overfrompreviousreportingperiod

For the first reporting period this should be zero.

Otherwise, this should equal thetotal number of youth served during the previous reporting period (Data section A.3 in the previous report) minus the total number of youth leaving the project during the previous reporting period (Data section C.1 in the previous report).

2.Number of new youth who participated during current reporting period

3.Total number of youth served during current reporting period

(A.1 plus A.2 above.)

B.Demographic Information

1.Total number of youth served by race/ethnicity:

Sum should equal A.3 above.

White (not Latino) American Indian/Alaskan Native

Black (not Latino)Asian

Latino Native Hawaiian/Pacific Islander

Other

  1. Total number of youth served by gender:

Sum should equal A.3 above.

Male Female

3.Total number of youth served by age:

Sum should equal A.3 above.

Under 11 12-13

14-15 16-17

18 and over

C.Number of Youth Leavingthe Project

The number of youth leaving the project during the reporting period, successfully and unsuccessfully.

1.Total number of youth leaving the project during the reporting period

2.Number of youth leaving the projectwhometProject Criteria

(Should be less than or equal to C.1.)

Project Criteria arethecriteria thatyouth must meet to successfully complete the project, which were listed in the Project Criteria section of the first report.

D.Number of Full-Time Equivalent (FTE) employees supported by project funds

If based on staff hours, divide the number of staff hoursworked during the reporting period by 520.

Is this the same as the previous reporting period? (Check one.)YesNo

E.Number of planning activities undertaken during the reporting period

Planning activities include meetings held, needs assessments undertaken, etc.

F.Number of Project Staff with Increased Knowledge of Project Area

Use a training evaluation or assessment form to collect this information.

This includes trainings or other formal learning opportunities for any staff who received project-related training during the reporting period. Training does not need to have been given by the project.

1.Total number of project staff trained during the reporting period

2.Number of project staff trained who reported increased knowledge

(Should be less than or equal to F.1.)

G.Number of times the Prevention Policy Board (PPB) met during the reporting period:

A Youth Survey Questionnaire designed to collect information for H, I, and J below is available on the OPM web site and from OPM program staff.

CompleteH below for youth who leave the project during the reporting period, successfully and unsuccessfully.

H.Number of Youth Satisfied with the Project

1.Total number of youth who returned surveys

2.Number of youth who reported they are satisfied on the surveys

(Report the number of youth who answered 6 or greater to question 13

on the Youth Survey Questionnaire. This number should be less than or

equal to H.1.)

Complete I and J below for the last reporting period of the grant.

I.Number of Youth Exhibiting Desired Change in Targeted Behaviors

1.Number of youth served who exhibit anincrease in school attendance

during the project:

(Report the number of youth who answered “Less” to question 4 on

the Youth Survey Questionnaire.)

  1. Number of youth served who exhibit a decrease in antisocial behavior

during the project:

(Report the number of youth who answered “Less” to 3 or more of

questions 8 through 12 on the Youth Survey Questionnaire.)

  1. Data on the number of youth served who exhibit a decrease in antisocial behavior must be collected and reported to OPM 6 months to 1 year after the end of the grant period. Please describe when and how you will collect these data.

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