Enforcing the Underage Drinking Laws

Enforcing the Underage Drinking Laws
Grant Program /

Demographic Form

Grantee: / Grant Number: / - EUD -
Month:

Education (Required During Grant Period)

How were the education sessions conducted? (Circle all that apply)
Public Speaking / Individual Counseling
Ages of individual(s) receiving education:
0-10 11-14 15-18 19-21 over 21 general population
Ages of groups receiving education:
0-10 11-14 15-18 19-21 over 21 general population
How many total people received education on underage drinking this month?
groups reaching approximately people and / or individuals

Compliance Checks (Required)

How many violations were written? In how many facilities?
Carry-outs and Retailers
Bars, Clubs, and Taverns
Other

Advertising

How many of each:
Billboards
TV Ads
Newspaper Ads / Radio Ads
Flyers
Other
Total for Month
Total for Entire Grant Period

Intervention and / or Diversion (If Applicable)

Do you have and intervention and / or diversion component in your program? yes no
If yes, answer the next 4 questions. If no, skip to the next section.

1. How many youth were identified to go through the diversion program?

1. Age group of those identified youth?

0-10 11-14 15-18 19-21 over 21

1. How man youth completed the intervention and / or diversion program?

0-10 11-14 15-18 19-21 over 21

1. What types of intervention did you use? (Write Answer)

Aftercare and / or Follow-up (If applicable – required if you do intervention or diversion)

Do you have an aftercare and / or follow-up component in your program? yes no
If yes, answer the next 6 questions. If no, skip to the next section.

1. How many kids did you follow-up with one month after they completed the program?

0-10 11-14 15-18 19-21 over 21

1. How many of those kids re-offended?

1. How many kids did you follow-up with three months after they completed the program?

0-10 11-14 15-18 19-21 over 21

1. How many of those kids re-offended?

1. How many kids did you follow-up with six months after they completed the program?

0-10 11-14 15-18 19-21 over 21

1. How many of those kids re-offended?

TOTAL FOR THE MONTH

How many total people received service during this month (education, intervention/diversion, and follow-up)?
adults under 21

TOTAL FOR THE ENTIRE GRANT PERIOD AS OF THIS REPORT

How many total people received services during the entire grant period (count each person only one time during the full grant period? For example, if a child received services in January, February, and March, you only count that child one time.
adults under 21