Form 1122-0005 Semi-annual Progress Report for Grants to Reduce Violent

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U.S. Department of Justice
Office on Violence Against Women
SEMI-ANNUAL PROGRESS REPORT FOR
Grants to Reduce Violent Crimes
Against Women on Campus Program
Brief Instructions: This form must be completed for each Grants to Reduce Violent Crimes Against Women
on Campus Program (Campus Program) grant received. A grant administrator or coordinator must ensure that
the form is completed fully with regard to all grant-funded activities. Grant partners, however, may complete
sections relevant to their portion of the grant. Grant administrators or coordinators are responsible for compiling and submitting a single report that reflects all information collected from grant partners.
All grantees should read each section to determine which questions they must answer, based on the activities engaged in under this grant during the current reporting period. Sections B, E, and F of this form must
be completed by all grantees. In section A, subsection A1 must be answered. In section C, subsection C1
must be answered. In Section D and subsections A2, C2-C6, grantees must answer an initial question about
whether they engaged in certain activities during the current reporting period. If the response is yes, then the
grantee must complete that section/subsection. If the response is no, the rest of that section/subsection is
skipped.
For example, 1) if you are a Campus Program grantee providing training and victim services with staff funded
under this grant, you should complete A1, A2, B, C1, C2, D, E, F (and answer “no” in C3-C6), or 2) if you are
a Campus Program grantee providing training with staff funded under this grant, you should complete A1, A2,
B, C1, C2, E, and F (and answer “no” in C3-C6 and D).
The activities of volunteers or interns may be reported if they are coordinated or supervised by Campus
Program-funded staff or if Campus Program funds substantially support their activities.
For further information on filling out this form, refer to the separate set of instructions, which contains
detailed definitions and examples, illustrating how questions should be answered.
Section
Section A:
Section B:
Section C:
C1:
C2:
C3:
C4:
C5:
C6:
Section D:
Section E:
Section F:
Appendix A:

General Information
Purpose Areas
Function Areas
Minimum Requirements
Training
Campus Education
Products
Data Collection and Communication Systems
System and Capital Improvement
Victim Services
Campus and Community Measures
Narrative
Status of Goals and Objectives Table

Page Number
1
4
5
5
11
14
16
17
18
19
22
24
25

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GENERAL INFORMATION
Grant Information

A1

All grantees must complete this subsection.
/

1.

Date of report

2.

Current reporting period

3.

Grantee name

4.

Grant number

/

(format date with 6 digits - 01/31/04)
✔

January 1-June 30

✔

July 1-December 31

(Year)

(the federal grant number assigned to your Campus Program grant)

5.

Type of lead institution
(Check the answer[s] that best describes the institution receiving the Campus Program funds. Check all that
apply.)

Public school
Private school
Tribal school

Historically black college
Other (specify):

6.

Is this a Higher Education Association Special Initiative to Address Violent Crimes on Campuses
grant?
Yes
No
If yes, identify the association:

7.

Is this a consortium project?
Yes
No
If yes, list each participating members and indicate the types of
institutions represented in your consortium.
Institution name:
(1)
(2)
(3)
(4)
Type of institution (Check the answer[s] that best describe the consortium members. Check all that apply.)

Public school
Private school
Tribal school
8.

Historically black college
Other (specify):

Point of contact
(person responsible for the day-to-day coordination or administration of the grant)
First Name
Last Name
MI

Name

Institution
different
from
grantee
name)
InstitutionName
name(if(if
different
from
grantee
name)

Address
Address

City
Telephone

State
Facsimile

Telephone
E-mail

Facsimilie

Zip Code

E-mail
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9.

Does this grant specifically address tribal populations?
(Check yes if your Campus Program grant focuses on tribal populations, and indicate which tribes or nations
you serve or intend to serve.)

Yes

No

If yes, which tribes/nations:

10. What percentage of your Campus Program funds was directed to each of these areas?
(Report the area[s] addressed by your Campus Program grant during the current reporting period and estimate the approximate percentage of funds [or resources] used to address each area [consider education,
training, victim services, etc.]. The grantee may choose how to make this determination. If the grant funds a
consortium, responses in this question should reflect the aggregated responses of consortium members.)
Throughout this form, the term sexual assault includes both assaults committed by offenders who are
strangers to the victim/survivor and assaults committed by offenders who are known to, or related by blood
or marriage to, or in a dating relationship with the victim. The term domestic violence applies to any pattern
of coercive behavior that is used by one person to gain power and control over a current or former intimate
partner. Domestic violence includes dating violence, which is violence committed by a person who is or has
been in a social relationship of a romantic or intimate nature with the victim. Stalking is defined as a course
of conduct directed at a specific person that places that person in reasonable fear of the death of, or serious
bodily injury to, herself or himself, a member of her/his immediate family, or her/his spouse or intimate partner. (See pages 3-4 of the separate instructions for more complete definitions.)
Percentage of grant funds
Sexual assault
Domestic violence
Stalking
TOTAL

100%0%

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A2

Staff Information

Were Campus Program funds used to fund staff positions during the current reporting period?
Check yes if Campus Program funds were used to pay staff, including part-time staff and contractors. (If the
grant funds a consortium, responses in this section should reflect the aggregated responses of consortium
members.)

Yes—answer question 11
No—skip to Section B
11. Staff
(Report the total number of full-time equivalent (FTE) staff funded by the Campus Program grant during the
current reporting period. Include employees who are part-time and/or only partially funded with these grant
funds as well as contractors. If an employee or contractor was not employed or utilized over the entire
reporting period, report the average. Round to the second decimal. See separate instructions for examples
of how to calculate FTEs for part-time staff and contractors.)
Staff

Grant-funded staff

Administrator (director, fiscal manager)
Campus police/security officer
Civil attorney
Counselor
Evaluator
Information technology specialist
Legal advocate
Program coordinator (training coordinator, victim services coordinator)
Support staff (secretary, administrative assistant)
Trainer/educator
Victim advocate
Other (specify):
TOTAL

0.00

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B

PURPOSE AREAS
All grantees must complete this section. (If the grant funds a consortium,
responses in this section should reflect the aggregated responses of consortium members.)

12. Statutory purpose areas
(Check all purpose areas that apply to activities supported by Campus Program funds during the current
reporting period.)
Check ALL
that apply

Purpose areas
To provide personnel, training, technical assistance, data collection, and other equipment with
respect to the increased apprehension, investigation, and adjudication of people committing
violent crimes against women on campus.
To train campus administrators, campus security personnel, and personnel serving on campus
disciplinary or judicial boards to more effectively identify and respond to violent crimes against
women on campus, including the crimes of sexual assault, stalking, domestic violence, and
dating violence.
To implement and operate education programs for the prevention of violent crimes against
women.
To develop, enlarge, or strengthen support services programs, including medical or psychological counseling, for victims of sexual offense crimes.
To create, disseminate, or otherwise provide assistance and information about victims’
options on and off campus to bring disciplinary or other legal action, including assistance to
victims in immigration matters.
To develop and implement more effective campus policies, protocols, orders, and services
specifically devoted to prevent, identify, and respond to violent crimes against women on campus, including the crimes of dating violence, domestic violence, sexual assault, and stalking.
To develop, install, or expand data collection and communication systems, including computerized systems, linking campus security to local law enforcement for the purpose of identifying
and tracking arrests, protection orders, violations of protection orders, prosecutions, and convictions with respect to violent crimes against women on campus, including the crimes of dating violence, domestic violence, sexual assault, and stalking.
To develop, enlarge, or strengthen victim service programs for the campus and to improve
delivery of victim services on campus.
To provide capital improvements (including improved lighting and communications facilities, but
not including the construction of buildings) on campuses to address violent crimes against
women on campus, including the crimes of dating violence, domestic violence, sexual assault,
and stalking.
To support improved coordination among campus administrators, campus security personnel,
and local law enforcement to reduce violent crimes against women on campus.

13. Program priority areas addressed by your grant
(In addition to the purpose areas identified above, the Campus Program Grant Application and Program
Guidelines may have identified several areas that would receive priority consideration. If your program
addressed any of these priority areas during the current reporting period, list them below.)

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C1

FUNCTION AREAS
Minimum Requirements

All grantees must complete this section. (If the grant funds a consortium,
responses in this section should reflect the aggregated responses of consortium members.)

For the purposes of this reporting form, education means providing general information that will increase
public awareness of sexual assault, dating violence, domestic violence, or stalking. Training means providing
information on sexual assault, dating violence, domestic violence, and stalking that enables
person to
to imimenables apersons
prove their response to victims/survivors as it relates to their role in the system.

14. Prevention and education program events provided for incoming students
(Report the total number of prevention and education program events supported with Campus Program funds
provided for incoming students during the current reporting period. Report the number of prevention and education program events supported with a funding source other than your Campus Program grant provided to incoming students during the current reporting period.)
Total number of prevention and education program events provided with Campus Program funds
Total number of prevention and education program events provided with other funding sources

15. Was the mandatory prevention and education program for incoming students developed in
collaboration with campus and community-based victim advocacy organizations?
Yes
No
16. Prevention and education for incoming students
(In the first column, report the number of incoming students during the current reporting period. In the second column, report the number of incoming students who received prevention and education supported with
Campus Program funds during the current reporting period. In the third column, report the number of incoming students who received prevention and education supported with a funding source other than Campus
Program funds during the current reporting period.)
Number incoming

Number educated with
Campus Program funds

Number educated with
other funding sources

Incoming students

17. Topics of prevention and education program events
(Indicate all topics addressed in the prevention and education program events provided to incoming students
during the current reporting period. Check all that apply.)

Dating violence prevention
Domestic violence prevention
Sexual assault prevention
Sexual harassment prevention
Stalking prevention
Dating violence overview, dynamics,
and services

Domestic violence overview, dynamics,
and services
Sexual assault overview, dynamics,
and services
Sexual harassment overview, dynamics,
and services
Stalking overview, dynamics, and services
Other (specify):

18. Do you evaluate your prevention and education program events for incoming students with preand/or post-tests?
(Check only one answer. If you conduct such tests, discuss results in question 55.)
Always

Most of the time

Some of the time

Rarely

Never

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19. Training program events provided for campus police/security officers and judicial/disciplinary
board members
(Report the total number of training program events supported with Campus Program funds provided for
campus police/security officers and judicial/disciplinary board members during the current reporting period.
Report the number of training program events supported with a funding source other than your Campus Program grant provided for campus police/security officers and judicial/disciplinary board members during the
current reporting period.)
Number provided with
Campus Program funds

Number provided with
another funding source

Campus police/security officers
Judicial/disciplinary board members

20. Were the training programs for campus police/security officers and judicial/disciplinary
board members developed in collaboration with campus and community-based victim advocacy
organizations?
Yes

No

21. Training for campus police/security officers and judicial/disciplinary board members
(In the first column, report the number of campus police/security officers and judicial/disciplinary board
members who received training supported with Campus Program funds during the current reporting period.
In the second column, report the number of campus police/security officers and judicial/disciplinary board
members who received training supported with a funding source other than Campus Program funds during
the current reporting period. In the third column, report the numbers of those who have not received training.)
Number trained with
Number trained with
Number
Campus Program funds another funding source not trained

Campus police/security officers
Judicial/disciplinary board members

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22. Training content areas
(Indicate all topics covered in training program events provided to campus police/security officers and
judicial/disciplinary board members during the current reporting period. Check all that apply.)

Sexual assault, domestic violence, and stalking
Confidentiality
Dating violence overview, dynamics,
and services
Domestic violence overview, dynamics,
and services
Drug-facilitated sexual assault
Safety planning for victims
Sexual assault overview, dynamics,
and services
Sexual harassment overview, dynamics,
and services
Stalking overview, dynamics, and services
Other (specify):

Justice and disciplinary systems
Campus police/security response
Civil court procedures
Criminal court procedures
Disciplinary/judicial board response
Domestic violence statutes/codes
Firearms and domestic violence
Identifying predominant aggressor/
decreasing dual arrests
Judicial response
Mandatory reporting requirements
Pro-arrest policies
Protection orders (including full faith and credit)
Sexual assault statutes/codes
Stalking statutes/codes
Other (specify):

Underserved populations
Issues specific to victims/survivors who:

live in rural areas
are American Indian or Alaska Native
are Asian
are black or African American
are disabled
are elderly
are Hispanic or Latino
are homeless or living in poverty
are immigrants, refugees, or asylum
seekers
are lesbian, gay, bisexual, transgender,
or intersex
are Native Hawaiian or other Pacific
Islander
have mental health problems
have substance abuse problems
Other (specify):
Campus and community response
Clery Act reporting
Coordinated community response
Response teams (DART, DVRT, SART)
Technology
Other (specify):

23. Do you evaluate training program events for campus police/security officers and judicial/
disciplinary board members with pre- and/or post-tests?
(Check only one answer. If you conduct such tests, discuss results in question 55.)
Always

Most of the time

Some of the time

Rarely

Never

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24. Coordinated campus-based community response activities supported by Campus Program funds
during the current reporting period
(Check the appropriate boxes to indicate the campus-based groups or offices, even if they are not partners
with which you have an internal memorandum of understanding [IMOU], that you provided victims/survivors
referrals to, received referrals from, engaged in consultation with, provided technical assistance to, and/or
attended meetings with, according to the usual frequency of those interactions. If the interactions were not
part of a regular schedule, you will need to estimate the frequency with which these interactions occurred
during the current reporting period. In the last column, indicate the campus-based groups or offices with
which you have an IMOU for the purposes of the Campus Program grant.)
Campus-based group
or office

Victim/survivor referrals,
consultations, technical assistance
Daily
Weekly Monthly

Meetings
Weekly

IMOU
Partner

Monthly Quarterly

Academic deans/
directors
Academic departments
Athletics department
Campus police/security
department
Counseling center
Disciplinary/judicial
office or board
Faculty Senate
Faith-based services
Greek affairs
Health center
Human resources
Men’s anti-violence
groups
President of the
institution
Residential life
Student affairs
(multicultural center,
career services)
Student groups
Student Senate
Victim services
Victim/survivor groups
Women’s center
Women’s anti-violence
groups
Other (specify):

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25. Coordinated community-based response activities supported by Campus Program funds during
the current reporting period
(Check the appropriate boxes to indicate the community-based agencies, organizations, or groups, even if
they are not partners with which you have an external memorandum of understanding [EMOU], that you provided victim/survivor referrals to, received referrals from, engaged in consultation with, provided technical
assistance to, and/or attended meetings with, according to the usual frequency of the interactions. If the
interactions were not part of a regular schedule, you will need to estimate the frequency with which these
interactions occurred during the current reporting period. In the last column, indicate the community-based
agencies, organizations, or groups with which you have an EMOU for purposes of the Campus Program grant.)
Community-based
agency/organization/
group

Victim/survivor referrals,
consultations, technical assistance
Daily

Weekly

Monthly

Meetings
Weekly

EMOU
Partner

Monthly Quarterly

Batterer Intervention
Program
Community advocacy
organization (NAACP,
LGBTQ organization)
Court
Domestic violence
program
Dual sexual assault
and domestic violence
program
Faith/spiritual-based
organization
Government agency
(vocational rehabilitation, food stamps, TANF)
Health/mental health
organization
Law enforcement
(excluding campus
police/security)
Legal organization
(legal services, bar
association)
Prosecutor’s office
Sexual assault program
Social service
organization
Tribal government/
Tribal government
agency
Other (specify):

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26. Types of policies or protocols developed, substantially revised, or implemented during the
current reporting period
(Check all the types of policies or protocols developed, substantially revised, or implemented during the
current reporting period. Check all that apply.)
Law enforcement
Campus Community
based
based

Appropriate response to underserved
populations
Identifying primary aggressor/discouraging dual arrest
Immediate access to protection order
information
Mandatory training on sexual assault,
domestic violence, and stalking
No victims polygraphed
Pro-arrest/mandatory arrest
Protection order enforcement (including
full faith and credit)
Providing information to victims/
survivors about victim services
Other (specify):
Victim services
Campus Community
based
based

Appropriate services for underserved
populations
Confidentiality
Disciplinary policy and procedures
Mandatory training standards for staff
and volunteers
Protocols with campus police/security
Staff, board, and/or volunteers represent the diversity of your service area
Victim/survivor informed about Crime
Victims Compensation and Victim
Impact Statements
Other (specify):
Health care
Campus Community
based
based

Advocate response to emergency
room/campus health center
Appropriate response to underserved
populations
Forensic evidence collection and
documentation
Mandatory training on sexual assault,
domestic violence, and stalking
Routine screening and referrals for
sexual assault, domestic violence,
and stalking
Other (specify):

Judicial/disciplinary board (campus based)
Accelerated hearing schedules
Appropriate response to underserved populations
Confidentiality
Mandatory training on sexual assault, domestic
violence, and stalking
Discouraging mediation
Procedures for disciplinary hearing security
Sanctions
Victim notification
Other (specify):
Justice system (community based)
Civil court procedures
Criminal court procedures
Decreasing dual arrests/identifying predominant
aggressor
Domestic violence statutes/codes
Firearms and domestic violence
Judicial response
Law enforcement response
Pro-arrest policies
Prosecution response
Protection orders (including full faith and credit)
Sexual assault statutes/codes
Stalking statutes/codes
Other (specify):
Student conduct code
Dating violence policy
Domestic violence policy
Sexual assault policy
Sexual harassment policy
Stalking policy
Other (specify):
Campus response
Cleary Act reporting
Data collection
Coordinated campus/community response
Response teams (DART, DVRT, SART)
Other (specify):

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Training

C2

Were your Campus Program funds used for training during the current reporting period?
Check yes if Campus Program-funded staff provided training or if grant funds directly supported the training.
(If the grant funds a consortium, response in this section should reflect the aggregated responses of consortium members.)

Yes—answer questions 27-30
No—skip to C3
For the purposes of this reporting form, training is providing information on sexual assault, dating violence,
domestic violence, and stalking that enables a person to improve their response to victims/survivors as it
relates to their role in the system. Education is providing general information that will increase public awareness of sexual assault, dating violence, domestic violence, or stalking. In this subsection, report information
on training activities. Report education activities in subsection C3.

27. Training provided
(Report the total number of training events provided with Campus Program funds during the current reporting
period. Exclude those events reported in subsection C1. Staff development training provided to Campus Program-funded staff should not be counted.)
Total number of training events provided

28. Do you evaluate training events with pre- and/or post-tests?
(Check only one answer. If you conduct such tests, discuss results in question 55.)
Always

Most of the time

Some of the time

Rarely

Never

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29. Number of people trained
(Report the number of people trained with Campus Program funds during the current reporting period. Use
the category that is most descriptive of the people attending the training event. Exclude those reported in
subsection C1.)
People trained

Number

Attorneys/law students
Batterer Intervention Program staff
Community advocacy organization staff (NAACP, LGBTQ organization)
Faculty/staff
Faith-based organization staff
Health professionals (doctors, nurses)
Law enforcement officers
Mental health professionals
Multidisciplinary group
Peer educators
Social service organization staff
Student affairs staff (residential life, multicultural center,
disability organization, LGBTQ)
Victim advocates (domestic violence)
Victim advocates (sexual assault)
Victim advocates (dual—sexual assault and domestic violence)
Volunteers
Other (specify):
TOTAL

0

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30. Training content areas
(Indicate all topics covered in training events provided by your Campus Program funds during the current reporting period. Do not include staff development events attended by Campus Program-funded staff. Check
all that apply.)

Sexual assault, domestic violence, and stalking
Confidentiality
Dating violence overview, dynamics,
and services
Domestic violence overview, dynamics,
and services
Drug-facilitated sexual assault
Safety planning for victims
Sexual assault overview, dynamics,
and services
Sexual harassment overview, dynamics,
and services
Stalking overview, dynamics, and services
Other (specify):

Justice and disciplinary systems
Campus police/security response
Civil court procedures
Criminal court procedures
Disciplinary/judicial board response
Domestic violence statutes/codes
Firearms and domestic violence
Identifying predominant aggressor/
decreasing dual arrests
Judicial response
Mandatory reporting requirements
Pro-arrest policies
Protection orders (including full faith
and credit)
Sexual assault statutes/codes
Stalking statutes/codes
Other (specify):

Underserved populations
Issues specific to victims/survivors who:

live in rural areas
are American Indian or Alaska Native
are Asian
are black or African American
are disabled
are elderly
are Hispanic or Latino
are homeless or living in poverty
are immigrants, refugees, or asylum
seekers
are lesbian, gay, bisexual, transgender,
or intersex
are Native Hawaiian or other Pacific
Islander
have mental health problems
have substance abuse problems
Other (specify):

Campus and community response
Clery Act reporting
Coordinated community response
Response teams (DART, DVRT, SART)
Technology
Other (specify):

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C3

Campus Education

Were your Campus Program funds used for campus education (outreach events, public awareness,
and/or prevention activities) during the current reporting period?
Check yes if Campus Program-funded staff were used to support campus education or if Campus Program
funds directly supported campus education. (If the grant funds a consortium, responses in this section
should reflect the aggregated responses of consortium members.)

Yes—answer questions 31-35
No—skip to C4
For the purposes of this reporting form, education means providing general information that will increase
public awareness of sexual assault, dating violence, domestic violence, or stalking. In this subsection, report information on prevention activities and education programs. Training means providing information on
sexual assault, dating violence, domestic violence, and stalking that enables a person to improve their response to victims/survivors as it relates to their role in the system. Training activities should be reported in
subsection C2.

31. Outreach activities
(Indicate the outreach activities supported with Campus Program funds during the current reporting period.
Check all that apply.)
Events

Clothesline Project
Concerts
Domestic Violence Awareness Month
Media campaigns (press conferences, public service announcements, articles)
Rallies/Speak Outs
Sexual Assault Awareness Month
Silent Witnesses
Stalking Awareness Month
Tabling at public events
Take Back the Night March
Theater productions
Video series
Vigils
Women’s History Month activities
Other (specify):
32. Prevention and education program events provided
(Report the total number of prevention and education program events provided during the current reporting
period that were either provided by Campus Program-funded staff or directly supported by Campus Program
funds. Exclude the prevention and education program events for incoming students reported in subsection
C1. Do not count outreach events reported in item 35.)
31.)
Total number of prevention and education program events provided

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09/30/2007

33. Prevention and education program attendees
(Report the number of people attending prevention and education program events provided with Campus
Program funds during the current reporting period. Use the category that is most descriptive of the people
attending the prevention or education program event. Exclude those reported in subsection C1.)
People attending

Number

Institution administrators (Provost, President)
Academic deans/directors
Varsity athletes
Faculty/staff
Fraternity/Sorority members
Men’s group participants
Parents of students
Residential life staff
Student affairs staff (multicultural center, LGBTQ center, career services)
Students (Club sports, intramurals, classroom)
Victims/survivors
Women’s group participants
Other (specify):
0

TOTAL

34. Topics of prevention and education programs
(Indicate all topics addressed in prevention and education programs provided with Campus Program funds
during the current reporting period. Check all that apply.)

Dating violence prevention
Domestic violence prevention
Self-defense
Sexual assault prevention
Sexual harassment prevention
Stalking prevention
Dating violence overview, dynamics,
and services

Domestic violence overview, dynamics,
and services
Sexual assault overview, dynamics, and
services
Sexual harassment overview, dynamics,
and services
Stalking overview, dynamics, and services
Other (specify):

35. Do you evaluate prevention and education program events with pre- and/or post-tests?
(Check only one answer. If you conduct such tests, discuss results in question 55.)
Always

Most of the time

Some of the time

Rarely

Never

Grants to Reduce Violent Crimes Against Women on Campus Program Semi-annual Progress Report • 15 • Office on Violence Against Women

C4

OMB Clearance # 1122-0005
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SECTION

Products

Were your Campus Program funds used to develop, substantially revise, or distribute
products during the current reporting period?
Check yes if Campus Program-funded staff developed, substantially revised, or distributed products or if Campus
Program funds directly supported the development, revision, or distribution of products. (If the grant funds a
consortium, responses in this section should reflect the aggregated responses of consortium members.)

Yes—answer question 16
No—skip to C5
36. Use of Campus Program funds for product development, substantial revision, or distribution
(Report the number of products developed, substantially revised, or distributed with Campus Program funds
during the current reporting period. Report the number of new products developed or substantially revised
during the current reporting period; the title/topic and intended audience for each product developed, revised,
or distributed; and the number of products used or distributed. If a product was created in or translated
into a language other than English, including Braille, indicate the language. Report on products that
were newly developed or revised during the current reporting period whether or not they were used or
distributed, and on products that were previously developed or revised but used or distributed during the
current reporting period.)
Number
developed
or revised

Title/topic

Intended
audience

Number
used or
distributed

Other
languages

Brochures

Manuals

Newsletter

Posters

Question 36 continued on next page
Grants to Reduce Violent Crimes Against Women on Campus Program Semi-annual Progress Report • 16 • Office on Violence Against Women

Number
developed
or revised

Title/topic

Intended
audience

Question 36 continued.
Number
Other
used or
languages
distributed

Promotional products (wallet cards, key rings, whistles, etc.)

Training materials (power point presentations, theatre scripts, etc.)

Training curricula

Website (indicate the number of page views in the number used or distributed column)

Other (specify)

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SECTION

OMB Clearance
OMB
Clearance## 1121-0258
1122-0005
Expiration Date:
Expiration
Date: 07/31/2004
09/30/2007

C5

Data Collection and Communication Systems

Were your Campus Program funds used for data collection systems or communication systems or for
the purchase of hardware or other equipment during the current reporting period?
Check yes if Campus Program funds or Campus program-funded staff were used to develop, install, or
expand data collection and/or communication systems. (If the grant funds a consortium, responses in this
section should reflect the aggregated responses of consortium members.)

Yes—answer questions 37-38
No—skip to C6
37. Use of Campus Program funds for data collection and/or communication systems
(Indicate whether Campus Program grant funds were used to develop, install, link or expand data collection
and/or communication systems, or purchase computers or other equipment during the current reporting
period. Check all that apply.)

Develop data collection/communication systems
Install data collection/communication systems
Expand existing data collection/communication systems
Link existing data collection/communication systems with local law enforcement
Share information with other community partners
Manage data collection and communication
Purchase computers and other equipment
38. Purpose of data collection and/or communication systems
(Indicate all types of information identified or tracked with this technology by checking all that apply.)

Arrests
Case management
Compliance with judicial/disciplinary board-ordered sanctions
Convictions
Evaluation/outcome measures
Incident reports
Judicial/disciplinary board conditions/violations
Judicial/disciplinary board hearing schedules
Prosecutions
Protection orders
Recidivism
Sentencing
Stalking and harassment orders
Victim notification
Victim service availability
Violations of protection orders
Other (specify):

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Crimes
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Women

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Clearance #
1121-0258
OMB
# 1122-0005
Expiration Date:
Date: 07/31/2004
Expiration
09/30/2007

C6

System and Capital Improvement

Were your Campus Program funds used for system and/or capital improvement (but not including
construction of buildings) during the current reporting period?
Check yes if Campus Program-funded staff engaged in system and/or capital improvement activities (but not
including construction of buildings) or if Campus Program funds directly supported system (e.g., interpreters,
evaluations, language lines) and/or capital improvements (e.g. improved lighting, emergency call boxes). If
the grant funds a consortium, responses in this section should reflect the aggregated responses of consortium members.

Yes—answer questions 39-40
No—skip to Section D
39. Use of Campus Program funds for system improvement
(Indicate the system improvement activities supported with your Campus Program funds.)
Victim services

Campus police/
security

Judicial/
disciplinary board

Evaluation
Interpreters
Language lines
Translation of forms and documents
Other (specify):
40. Use of Campus Program funds for capital improvements
(Indicate the capital improvements supported with Campus Program funds during the current reporting
period. Capital improvements do not include the construction of buildings. Check all that apply.)
Capital improvements

Emergency call boxes
Landscape design for security
Lighting
Security cameras
Other (specify):

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SECTION

OMB Clearance
OMB
Clearance## 1121-0258
1122-0005
Expiration Date:
Expiration
Date: 07/31/2004
09/30/2007

D

VICTIM SERVICES

Were your Campus Program funds used to provide victim services to victims/survivors during the
current reporting period?
Check yes if Campus Program-funded staff provided victim services or if Campus Program funds were used
to support victim services during the current reporting period. (If the grant funds a consortium, responses in
this section should reflect the aggregated responses of consortium members.)

Yes—answer questions 41-47
No—skip to Section E
41. Number of victims/survivors served, partially served, and victims/survivors seeking services
who were not served
Please do not answer this question without referring to the separate instructions for further explanation and
examples of how to distinguish among these categories.
(Report the following, to the best of your ability, as an unduplicated count for each category during the current reporting period. This means that each victim/survivor who sought or received services during the current reporting period should be counted only once and in only one of the listed categories. For the purpose of
this question, victims/survivors are those against whom the sexual assault, domestic violence, and/or stalking was directed. If the victim/survivor presented with more than one victimization, that person should be
counted only once under the primary victimization.)
Sexual
assault

Domestic
violence

Stalking

A. Served: Victims/survivors who received the service(s) they
needed, if those services were provided under your Campus
Program grant
B. Partially served: Victims/survivors who received some
service(s), but not all of the services they needed, if those
services were provided under your Campus Program grant
C. Victims/survivors seeking services who were not served:
Victims/survivors who sought service and did not receive
the service(s) they needed, if those services were provided
under your Campus Program grant
42. Reasons that victims/survivors seeking services were not served or were partially served
(Check all that apply.)
Reasons not served or partially served

Program reached capacity
Need not documented
Did not meet eligibility or statutory
requirements
Program rules not acceptable to victim/
survivor
Services not appropriate for victim/survivor
Transportation problems
Conflict of interest
Services inappropriate or inadequate for
victims/survivors with substance abuse
problems

Reasons not served or partially served

Services inappropriate or inadequate for
victims/survivors with mental health problems
Insufficient/lack of adequate language
capacity (including sign language)
Geographic or other isolation of victim/survivor
Hours of operation
Insufficient/lack of culturally appropriate
services
Insufficient/lack of services for people with
disabilities
Other (specify):

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Progress
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• •19
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WomenononCampus
CampusProgram
Program
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OMB Clearance
OMB
Clearance## 1121-0258
1122-0005
Expiration Date:
Expiration
Date: 07/31/2004
09/30/2007

43. Demographics of victims/survivors served or partially served
(Based on the victims/survivors reported in 41A and 41B, report the total numbers for all that apply. This
should be an unduplicated count for “gender” and “age”.)

Race/Ethnicity (victims/survivors may be counted for
each race/ethnicity that applies)

Number of victims/survivors

Black or African American
American Indian and Alaska Native
Asian
Native Hawaiian and other Pacific Islander
Hispanic or Latino
White
Unknown
Gender

Number of victims/survivors

Female
Male
Unknown
TOTAL (should
equal sum of0 41A
, the and
sum 41B)
of 41A and 41B)
(Shoud equal
Age

0
Number of victims/survivors

0-17
18-24
25-59
60+
Unknown
, the sum
of 41A and 41B)
TOTAL (should
equal sum of0 41A
and 41B)
(Shoud equal
Other demographics

0
Number of victims/survivors

People with disabilities
People with limited English proficiency
People who are immigrants/refugees/asylum seekers
People who live in rural areas
44. Victims/survivors’ relationship to offender
(For those victims/survivors reported in 41A and 41B, report the relationship of the victim/survivor to the
offender by type of victimization. If a victim/survivor experienced more than one type of victimization and/or
was victimized by more than one perpetrator, count the victim/survivor in all categories that apply. The
number of victims/survivors reported here may total more than the sum of 41A and 41B.)
Sexual Domestic
Relationship to offender
assault violence Stalking

Current or former spouse or intimate partner
Other family or household member (in-law, grandparent, etc.)
Acquaintance (friend, neighbor, co-worker, schoolmate, professor, etc.)
Dating relationship
Stranger
Relationship unknown
Other (specify):
TOTAL

0

0

0

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ViolentCrimes
CrimesAgainst
AgainstWomen
WomenononCampus
Campus
Program
Semi-annual
Progress
Report
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OMB Clearance
OMB
Clearance## 1121-0258
1122-0005
Expiration Date:
Expiration
Date: 07/31/2004
09/30/2007

45. Victim services
(Report the number of victims/survivors from 41A and 41B provided with victim advocacy; face-to-face crisis
intervention; hotline call assistance; support group; counseling services; hospital response; legal advocacy
or court accompaniment; civil legal assistance; disciplinary board advocacy; and housing assistance. A victim/survivor may be counted once for each type of service received during the current reporting period. The
numbers of victims/survivors reported here may total more than the sum of 41A and 41B.)
Type of service

Number of
victims/survivors

Victim advocacy (Actions designed to help the victim/survivor obtain needed
support, resources, or services including employment, health care, victim’s
compensation, etc.)
Crisis intervention (Crisis intervention is a process by which a person identifies,
assesses, and intervenes with an individual in crisis so as to restore balance and
reduce the effects of the crisis in her/his life. In this category, report only crisis
intervention that occurs in person.)
Hotline calls (Crisis or information and referral calls received by a program’s
hotline or office telephone.)
Support group/Counseling services (Individual or group counseling or
support provided by a volunteer, peer, or professional.)
Hospital response (Accompanying or meeting a victim/survivor at the
hospital, usually for a forensic exam.)
Legal advocacy/Court accompaniment (Assisting a victim/survivor with legal issues including preparing paperwork such as victim impact statements, accompanying a victim/survivor to a court proceeding or law enforcement interview, and all
other advocacy with the criminal or civil justice system.)
Civil legal assistance (Civil legal services provided by an attorney.)
Disciplinary board advocacy (Assisting a victim/survivor with issues relating to
campus disciplinary board actions such as preparation of statements, accompanying the victim/survivor to disciplinary board hearings, and all other advocacy relating to campus-based proceedings.)
Housing assistance (Assisting a victim/survivor with housing issues including finding a room in a different dorm or finding temporary housing either on- or off-campus; preventing access by the perpetrator to the victim/survivor’s new residence.)
Other (specify):

46. Number of victims reporting crimes
(Of the victims/survivors who sought services provided under your Campus Program grant, provide the number who reported crimes of sexual assault, domestic violence, and/or stalking, to campus police/security or
community law enforcement during the current reporting period.)
Where crime occurred

Campus police/security

Community law enforcement

On-campus
Off-campus
47. Protection orders
(Report the total number of temporary and/or final protection orders requested and granted for which
Campus Program-funded victim services staff provided assistance to victims/survivors during the current
reporting period.)
Temporary protection orders
Final protection orders

Number of protection orders requested
Number of protection orders granted
Grants
Violent
Crimes
Against
Women
on on
Campus
Program
Semi-annual
Progress
Report
• 2• 1
Violence Against
GrantstotoReduce
Reduce
Violent
Crimes
Against
Women
Campus
Program
Semi-annual
Progress
Report
22•• Office on Violence
Against Women
Women

SECTION

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OMB
Clearance## 1121-0258
1122-0005
Expiration Date:
Expiration
Date: 07/31/2004
09/30/2007

Campus and Community Measures

E

All grantees must complete this section.
(If the grant funds a consortium, responses in this section
should reflect the aggregated responses of consortium members.)

In this section, use the numbers from your Clery Act report to provide information for the entire campus
or for the campuses represented in your consortium, to the extent that the information is available.
This applies to all sexual assault, domestic violence, and stalking offenses that occurred on campus,
or in or on noncampus buildings or property, and on public property, as defined by the Clery Act (20 U.S.C.
§1092(f)(6)), that were reported to campus security authorities or local law enforcement. Campus security
authorities are not restricted to campus police/security officers. See page 17 of the separate instructions for
the definitions of “campus” (to include noncampus buildings or property, and public property) and “campus
security authorities” as defined by the Clery Act. See page 3 of the separate instructions for complete definitions of sexual assault, domestic violence, and stalking.

48. Number of offenses reported
(Report the number of sexual assault, domestic violence, and/or stalking offenses reported to campus security authorities, as defined by the Clery Act and supporting regulations, during the current reporting period.)
Type of offense

Number of offenses reported

Sexual assault
Domestic violence
Stalking
TOTAL

0

49. Number of criminal offenses charged and campus disciplinary or judicial board actions
(Report the number of offenses in which criminal charges were filed in the local jurisdiction and/or in which
campus disciplinary/judicial board actions were held during the current reporting period.)

a. Number of offenses resulting in criminal charges being filed in the local jurisdiction
b. Number of offenses resulting in campus disciplinary/judicial board actions
50. Dispositions of campus disciplinary or judicial board actions
(Report the dispositions of all campus disciplinary or judicial actions resolved during the current reporting
period.)
Type of offense

Number dismissed
Request
of victim

Lack of
evidence

0

0

Sanctions
Reprimand

Other

Suspension

Expulsion

Counseling

Community
Service

Other

Sexual assault
Domestic
violence
Stalking
TOTAL

0

0

0

0

0

0

0

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• •22
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CrimesAgainst
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Women
Campus
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Semi-annual
Progress
Report
23 •• Office

OMB Clearance
Clearance # 1122-0005
1121-0258
OMB
Expiration Date:
Date: 07/31/2004
Expiration
09/30/2007

51. Dispositions of criminal charges
(Report the dispositions of all criminal charges filed in the local jurisdiction that were resolved during the
current reporting period. [Deferred adjudication is a process in which the judge requires the defendant to
adhere to certain terms, prior to any adjudication of guilt. If a defendant successfully completes those terms,
the charges are dismissed.])
Type of offense

Number dismissed
Request Lack of
Plea
of victim evidence bargain

Number convicted
Number of
deferred
Guilty of Guilty of Plead as
Plead
charged
lesser
lesser
adjudications highest

Other

Number
acquitted

Sexual assault
Domestic violence
Stalking
TOTAL

0

0

0

0

0

0

0

0

0

0

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Campus
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24 •• Office

SECTION

OMB Clearance
Clearance # 1122-0005
1121-0258
OMB
Expiration Date:
Date: 07/31/2004
Expiration
09/30/2007

F

Narrative

All grantees must answer question 52. (If the grant funds a consortium, response to this question
should reflect the aggregated responses of consortium members.)
Please limit your response to four pages for this question. To answer this question go to Page 26.
52. Report on the status of your Campus Program grant goals and objectives as of the end of the
current reporting period.
(Using Appendix A as a guide, report on the status of the goals and objectives for your grant as of the end of
the current reporting period, as they were identified in your grant proposal or as they have been added or revised. Indicate whether the activities related to your objectives for the current reporting period have been
completed, are in progress, are delayed, or have been revised. Comment on your successes and challenges,
and provide any additional explanation you feel is necessary for us to understand what you have or have not
accomplished relative to your goals and objectives. If you have not accomplished objectives that should have
been accomplished during the current reporting period, you must provide an explanation.)

All grantees must answer questions 53 and 54 on an annual basis. Submit this information on the
January to June reporting form only. (If the grant funds a consortium, responses to these questions
should reflect the aggregated responses of consortium members.)
Please limit your response to two pages for each question.
53. What do you see as the most significant areas of remaining need, with regard to increasing
victim/survivor safety and offender accountability? To answer this question go to Page 29.
(Consider underserved populations, campus-community collaborations, judicial/disciplinary board response,
student safety, challenges implementing prevention and education programs across campus, and/or challenges and barriers unique to your institution or service area.)

54. What has Campus Program funding allowed you to do that you could not do prior to receiving
this funding? To answer this question go to Page 31.
(For example, the money allowed us to make capital improvements; install data collection or communication
systems; revised judicial/disciplinary board procedures; create and implement prevention and education
programs; and train campus administrators, judicial/disciplinary board members, and security personnel.)

Question 55 is optional.
Please limit your response to two pages for this question.
55. Provide additional information that you would like us to know about your Campus Program and/
or the effectiveness of your grant. To answer this question go to Page 33.
(If you feel that the data you have provided does not fully or accurately reflect the effectiveness of your Campus Program or grant-funded activities, you may wish to provide supplemental data. If you have not already
done so elsewhere on this form, feel free to discuss any of the following: institutionalization of staff positions, policies, and/or protocols, systems-level changes, community collaboration, results of pre-tests and
post-tests, the removal or reduction of barriers and challenges for victims/survivors, utilization of volunteers
and/or interns to complete activities, promising practices, and positive or negative unintended consequences.)
Public Reporting Burden
Paperwork Reduction Act Notice. Under the Paperwork Reduction Act, a person is not required to respond to a collection
of information unless it displays a currently valid OMB control number. We try to create forms and instructions that are
accurate, can be easily understood, and which impose the least possible burden on you to provide us with information.
The estimated average time to complete and file this form is 60 minutes per form. If you have comments regarding the
accuracy of this estimate, or suggestions for making this form simpler, you can write to the Office on Violence Against
Women, U.S. Department of Justice, 810 7th Street, NW, Washington, DC 20531.
Grants
Program
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Progress
Report
• •24
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Women
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to Reduce
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ViolentCrimes
CrimesAgainst
AgainstWomen
WomenononCampus
Campus
Program
Semi-annual
Progress
Report
25 •
• Office

APPENDIX A

OMB Clearance # 1122-0005
Expiration Date: 09/30/2007

Describe your goals and objectives, as outlined in your grant proposal, or as revised - Question #52
Goals/Objectives

Back to Instructions

Status

Key Activities

Comments

Goals/Objectives

Back to Instructions

Status

Key Activities

Comments

Grants to Reduce Violent Crimes Against Women on Campus Program Semi-annual Progress Report • 26 • Office on Violence Against Women

APPENDIX A

OMB Clearance # 1122-0005
Expiration Date: 09/30/2007

Describe your goals and objectives, as outlined in your grant proposal, or as revised - Question #52 (cont. 1)

Back to Instructions

Status

Back to Instructions

Status

Goals/Objectives

Key Activities

Comments

Goals/Objectives

Key Activities

Comments

Grants to Reduce Violent Crimes Against Women on Campus Program Semi-annual Progress Report • 27 • Office on Violence Against Women

APPENDIX A

OMB Clearance # 1122-0005
Expiration Date: 09/30/2007

Describe your goals and objectives, as outlined in your grant proposal, or as revised - Question #52 (cont. 2)

Back to Instructions

Status

Back to Instructions

Status

Goals/Objectives

Key Activities

Comments

Goals/Objectives

Key Activities

Comments

Grants to Reduce Violent Crimes Against Women on Campus Program Semi-annual Progress Report • 28 • Office on Violence Against Women

What do you see as the most significant areas of remaining need, with regard to increasing
victim/survivor safety and offender accountability? - Question #53

OMB Clearance # 1122-0005
Expiration Date: 09/30/2007

Back to Instructions
Grants to Reduce Violent Crimes Against Women on Campus Program Semi-annual Progress Report • 29 • Office on Violence Against Women

What do you see as the most significant areas of remaining need, with regard to increasing
victim/survivor safety and offender accountability? - Question #53 (cont.)

OMB Clearance # 1122-0005
Expiration Date: 09/30/2007

Back to Instructions
Grants to Reduce Violent Crimes Against Women on Campus Program Semi-annual Progress Report • 30 • Office on Violence Against Women

What has Campus Program funding allowed you to do that you could not do prior to
receiving this funding? - Question #54

OMB Clearance # 1122-0005
Expiration Date: 09/30/2007

Back to Instructions
Grants to Reduce Violent Crimes Against Women on Campus Program Semi-annual Progress Report • 31 • Office on Violence Against Women

What has Campus Program funding allowed you to do that you could not do prior to receiving
this funding? - Question #54 (cont.)

OMB Clearance # 1122-0005
Expiration Date: 09/30/2007

Back to Instructions
Grants to Reduce Violent Crimes Against Women on Campus Program Semi-annual Progress Report • 32 • Office on Violence Against Women

Provide additional information that you would like us to know about your Campus Program
and/or the effectiveness of your grant - Question #55

OMB Clearance # 1122-0005
Expiration Date: 09/30/2007

Back to Instructions
Grants to Reduce Violent Crimes Against Women on Campus Program Semi-annual Progress Report • 33 • Office on Violence Against Women

Provide additional information that you would like us to know about your Campus Program
and/or the effectiveness of your grant - Question #55 (cont.)

OMB Clearance # 1122-0005
Expiration Date: 09/30/2007

Back to Instructions
Grants to Reduce Violent Crimes Against Women on Campus Program Semi-annual Progress Report • 34 • Office on Violence Against Women

OMB Clearance # 1122-0005
Expiration Date: 09/30/2007

Validate