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

OMB Clearance # 1121-NNNN

Expiration Date / /

U.S. Department of Justice

Office on Violence Against Women

Semi-Annual Progress Report for

Grants to Reduce Domestic Violence, Dating violence,

Sexual Assault, and Stalking on Campus Program

Brief Instructions: This form must be completed for each Grants to Reduce Domestic Violence, Dating violence,

Sexual Assault, and Stalking 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 grantee may be asked to explain, and 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 should be reported if they were coordinated or supervised by Campus Program-funded staff or if Campus Program funds substantially supported 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 Page Number, check after edits

Section A: General Information 1

A1 Grant Information

A2 Staff Information

Section B: Purpose Areas 5

Section C: Function Areas 6

C1 Minimum Requirements 6

C2 Training 11

C3 Campus Education 13

C4 Products 15

C5 Data Collection and Communication Systems 16

C6 System and Capital Improvement 17

Section D: Victim Services 18

Section E: Campus and Community Measures 23

Section F: Narrative 25

A. GENERAL INFORMATION

A1. Grant Information

All grantees must complete this subsection.

1. Date of report ____________________

2. Current reporting period  January 1-June 30  July 1-December 31 _________ (Year)

3. Grantee name

4. Grant number (the federal grant number assigned to your Campus Program grant)

5a. Type of lead institution (Check the answer that best describes the institution receiving the Campus Program funds.)

• Public school

• Private school

5b. Additional designations of lead institution (Check all that apply.)

• Tribal college or university

• Historically black college or university

• Faith-based college or university

• Community college

• College or university serving primarily Latino or Hispanic populations

• University or colleges based in the territories of Guam, Virgin Islands, Puerto Rico, Northern Mariana Islands, or American Samoa

• College or university serving primarily either men or women

• 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: ____________________________________________

7a. Is this a consortium project?

• Yes  No

7b. Is this a flagship project?

• Yes  No

7c. If you answered yes to either 7a. or 7b. above, list each participating member and indicate the number of each type of institution represented in your project.

Institution name:

(1) ______________________________________________________________

(2) ______________________________________________________________

(3) ______________________________________________________________

(4) ______________________________________________________________

7d.Type of institution (Report the number of each type of institution of your project members.)

Public school
Private school

7e. Additional designation of participating institutions (Report the number of each type of institution represented in your project.)

Tribal school
Historically black college
Faith-based
Community college
Latino/a/Hispanic
Territory-based
Single sex
Other (specify):

8 . Point of contact (person responsible for the day-to-day coordination of the grant)

First name _________________ MI _____ Last name _________________________________

Institution name (if different from grantee name) _________________________________________

Address

City ___________________________________ State ________ Zip _______________________

Telephone Facsimile

E-mail ______________________________

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 Campus Program grant funds a consortium or flagship project, responses in this question should reflect the aggregated responses of project 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, related by blood or marriage to, or in a dating relationship with the victim. The term domestic violence/ dating 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 or dating partner. (See pages 3-4 the separate instructions for more complete definitions.)

	Percentage of grant funds
Sexual assault
Domestic violence/dating violence
Stalking
TOTAL	100%

A 2. 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 or flagship project, responses in this section should reflect the aggregated responses of project 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. Report staff by functions performed, not by title or location. Include employees who are part-time and/or only partially funded with these grant funds as well as consultants/contractors. If an employee or contractor was employed or utilized for only a portion of the reporting period, prorate appropriately. For example, if you hired a full-time advocate in October who was 100% funded with Campus Program funds, you would report that as .50 FTEs. Report all FTEs in decimals, not percentages. One FTE is equal to 1,040 hours—40 hours per week x 26 weeks. See separate instructions for examples of how to calculate and prorate FTEs.)

Staff	FTEs
Administrator (director, fiscal manager)
Attorney
Campus police/security officer
Counselor
Evaluator
Information technology staff
Legal advocate (does not include attorney or paralegal)
Paralegal
Program coordinator (training coordinator, victim services coordinator)
Support staff (administrative assistant, bookkeeper, accountant)
Trainer/educator (includes peer educators if paid)
Victim advocate (includes domestic violence, sexual assault, dual)
Other (specify): ___________________________________________
TOTAL

B. PURPOSE AREAS

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

12. Statutory purpose areas (Check all purpose areas that apply to activities supported with 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 domestic violence, dating violence, sexual assault, and stalking on campus.
	To develop and implement campus policies, protocols, and services that more effectively identify and respond to the crimes of domestic violence, dating violence, sexual assault, and stalking, and to train campus administrators, campus security personnel, and personnel serving on campus disciplinary boards on such policies, protocols, and services.
	To implement and operate education programs for the prevention of domestic violence, dating violence, sexual assault, and stalking. .
	To develop, enlarge, or strengthen victim services programs on the campuses of institutions involved, including programs providing legal, medical, or psychological counseling, for victims of domestic violence, dating violence, sexual assault, and stalking, and to improve delivery of victim assistance on campus.
	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, 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 the crimes of domestic violence, dating violence, sexual assault, and stalking on campus.
	To provide capital improvements (including improved lighting and communications facilities, but not including the construction of buildings) on campuses to address 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 domestic violence, dating violence, sexual assault, and stalking 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.)

C. FUNCTION AREAS

C1. Minimum Requirements

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

For 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 persons to improve 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

Total number of prevention and education program events provided -----------------

15. Was the mandatory prevention and education program for incoming students developed in collaboration with campus and community-based victim advocacy organizations?

 Yes  No

16a. 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.)

	Total Number incoming Students	Number educated with Campus Program funds	Number educated with other funding sources	Number Incoming not Educated
Incoming students

16b. If all incoming students were not provided with prevention education, please explain in the box below.

17. Topics of prevention and education program events for incoming students (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

• Stalking overview, dynamics, and services

• Other (specify): _________________________

18. 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. Report total number of events for each group and each funding source in the total sections.)

	Number provided with Campus Program funds	Number provided with another funding source	Total Events Provided
Campus police/security officers
Judicial/disciplinary board members
Total events

19. 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

20. 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 did not received training during the current reporting period, and in the last column, report the total. Report the total of each column in the last row.)

	Number trained with Campus Program funds	Number trained with another funding source	Number not trained	Total
Campus police/security officers
Judicial/disciplinary board members
Total

2 1. Training content areas for campus police/security officers and judicial/disciplinary board members (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, dating violence, 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

• Stalking/cyberstalking overview, dynamics, and services

• Response to victims who have been trafficked

• 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

• have disabilities

• 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 issues

• have substance abuse issues

• have limited English proficiency

• Other (specify):

• Campus and community responseCampus response to sexual assault

• Clery Act reporting

• Coordinated community response

• Response teams (DART, DVRT, SART)

• Technology

• Other (specify):

2 2. 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			Meetings			IMOU partner
	Daily	Weekly	Monthly	Weekly	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): _____________________							

23 (Optional) Additional information (Use the space below to discuss the effectiveness of your campus-based coordinated community response (CCR) activities and to provide any additional information you would like to share about your campus-based CCRactivities beyond what you have provided in the data above. Examples might include improved information to victims regarding available resources and greater coordination between departments on campus.)

24. 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. If Campus Program-funded staff participated in a task force or work group, indicate that under “Meetings” by checking the frequency of the meetings and the types of organizations participating. 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			Meetings			EMOU partner
	Daily	Weekly	Monthly	Weekly	Monthly	Quarterly
Advocacy organization (NAACP, LGBTQ organization)							
Batterer intervention program							
Court							
Domestic violence organization							
Dual sexual assault and domestic violence organization							
Educational institutions/organizations
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, law school)							
Prosecutor’s office							
Sexual assault organizationoroorganization							
Sex offender treatment program
Social service organization							
Tribal government/Tribal government agency							
Other (specify): __________________________________							

24A. Number of communities with improved CCR capacity (Provide the number of communities that have improved their capacity to respond to domestic violence, dating violence, sexual assault, and stalking as a result of the coordinated community response activities described above. For purposes of this question, a community may be defined as a city or town that you serve; in larger metropolitan areas a “community” may be a neighborhood or borough.)

Number of communities _____________

25. (Optional) Additional information (Use the space below to discuss the effectiveness of your community-based CCR activities and to provide any additional information you would like to share about your community-based CCR activities beyond what you have provided in the data above. Examples might include an improved response to victims of domestic violence following meetings of a regional task force; improved information to victims regarding resources and greater coordination between the campus and the local victim services agency as the result of meetings between campus and community advocates.)

2 6. 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 based	Community 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, dating violence, and stalking
		Procedures for anonymous, confidential, or Jane Doe reporting of sexual assault
		Sexual assault response and protocols
		Policies to protect victims from internet disclosure of identifying information
		No charge to victim/survivors for any costs related to the prosecution of sexual assault, domestic violence/dating violence, and/or stalking
		No charge to sexual assault victim/survivor for any costs associated with forensic exam
		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 based	Community based
		Appropriate services for underserved populations
		Appropriate response to victim/survivors with substance abuse issues and /or mental health diagnoses
		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
		Procedures for anonymous, confidential, or Jane Doe reporting of sexual assault
		Victim/survivor informed about Crime Victims Compensation and Victim Impact Statements
		Other (specify):

Health care

Campus based	Community 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, dating violence, and stalking
		Routine screening and referrals for sexual assault, domestic violence, dating violence, and stalking
		Other (specify):____________________

Judicial/disciplinary board (campus based)

• Accelerated hearing schedules

• Appropriate response to underserved populations

• Confidentiality

• Mandatory training on sexual assault, dating violence, 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/dating violence statutes/codes

• Firearms and domestic violence/dating violence

• Judicial response

• Law enforcement response

• Pro-arrest policies

• Prosecution response

• Protection orders (including full faith and credit)

• Sexual assault response and protocols

• Sexual assault statutes/codes

• Stalking statutes/codes

• Other (specify): _______________________

Student conduct code

• Dating violence policy

• Domestic violence policy

• Sexual assault policy

• Stalking policy

• Other (specify): ________________________________

Campus response

• Clery Act reporting

• Data collection

• Coordinated campus/community response

• Response teams (DART, DVRT, SART)

• Sexual assault response and protocols

• Other (specify): ______________________

27. (Optional) Additional information (Use the space below to discuss the effectiveness of policies you have developed or implemented and to provide any additional information you would like to share about your activities relating to the developing, revising or implementing of policies beyond what you have provided in the data above.)

C2. Training

W ere 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 or flagship project, response in this section should reflect the aggregated responses of project members.)

• Yes--answer questions 27-29

• 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 professionals 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 events 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, Minimum Requirements, where you report on events provided for incoming students and campus police/security and judicial disciplinary board members. Training provided to Campus Program-funded staff should not be counted.)

Total number of training events provided

28. 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. Campus Program-funded staff attending training events should not be counted as people trained. If you are unable to report attendees in a specific category because of lack of information, you may report them in “Multidisciplinary,” but this category should be used only as a last resort. Students, community members, and victims should not be reported as people trained, since they are not professionals responding to victims.)

People trained	Number
Advocacy organization staff (NAACP, LGBTQ organization)
Attorneys/law students
Batterer intervention program staff
Educators (teachers, administrators, etc.)
Faith-based organization staff
Health professionals (doctors, nurses, health center staff)
Law enforcement officers
Mental health professionals
Multidisciplinary)
Peer educators
Pre-professional students (students who will serve victims in a professional capacity upon completion of their program, e.g., Social Work, Medical, Psychology students)
Sex offender management/sex offender treatment providers
Social service organization staff (non-governmental, e.g., food bank, homeless shelter)
Student affairs staff (residential life, multicultural center, disability organization, LGBTQ)
Victim advocates (includes domestic violence, sexual assault, dual)
Volunteers
Other (specify): ___________________________________________________
TOTAL

29. 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, dating 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

• Stalking overview, dynamics, and services

• Response to victims who are incarcerated

• Response to victims who have been trafficked

• 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:

• are American Indian or Alaska Native

• are Asian

• are black or African American

• are elderly

• are Hispanic or Latino

• are homeless or living in poverty

• are immigrants, refugees, or asylum seekers

• are international students

• are lesbian, gay, bisexual, transgender, or intersex

• are Native Hawaiian or other Pacific Islander

• are non-traditional or older students

• have disabilities

• have limited English proficiency

• have mental health issues

• have substance abuse issues

• live in rural areas

• Other (specify):

Campus and community response

• Clery Act reporting

• Community response to sexual assault

• Coordinated community response

• Response teams (DART, DVRT, SART)

• Technology

• Other (specify): _____________________

30. (Optional) Additional information (Use the space below to discuss the effectiveness of your training activities and to provide any additional information you would like to share about your training activities beyond what you have provided in the data above. Examples might include improved system response to victims with disabilities following a multidisciplinary training on issues specific to victims with disabilities, or greater awareness and reporting of drug-facilitated sexual assault.)

C3. Campus Education

W ere 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 or flagship project, responses in this section should reflect the aggregated responses of project members.)

• Yes--answer questions 31-33

• No--skip to C4

For 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 professionals to improve their response to victims/survivors as it relates to their role in the system. In this subsection, report information on education activities. Report training activities in subsection C2..

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

Activities	Sexual assault	Dating Violence	Domestic violence	Stalking
Community organizing/community events (rallies, speak outs, take back the night, vigils)
Educational exhibits (clothesline project, silent witness, information tables)
Media campaigns (press conferences, public service announcements, articles)
Productions for public awareness (video series, theater productions)
Other (specify):

32 Education program attendees (Report the number of people attending 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 education program event. Exclude those reported in subsection C1.)

People attending	Number
Institution administrators (Provost, President)
Academic deans/directors
Athletics (including athletes, coaches, athletics department)
Faculty/staff
Fraternity/Sorority members
Parents of students
Residential life staff
Student affairs staff (multicultural center, LGBTQ center, career services)
Students (Club sports, intramurals, classroom, non-traditional, international, etc., excluding those in section C1)
Victims/survivors
Women’s group participants
Community members/general public
Other (specify): ___________________________________________________
TOTAL

33. Topics of education programs (Indicate all topics addressed in 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

• Stalking prevention

• Dating violence overview, dynamics, and services

• Domestic violence overview, dynamics, and services

• Sexual assault overview, dynamics, and services

• Stalking overview, dynamics, and services

• Other (specify): _________________________

34. (Optional) Additional Information Use the space below to discuss the effectiveness of your outreach and education activities and to provide any additional information you would like to share about those activities beyond what you have provided in the data above. Examples might include a marked increase in calls from victims of sexual violence to your hotline following a Take Back the Night rally held on the campus commons, or during a Clotheslines Project exhibition.

C4. 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 or flagship project, responses in this section should reflect the aggregated responses of project members.)

• Yes--answer question 35

• No--skip to C5

35. 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. Do not report the number of products printed or copied; only report the number developed or revised—in most cases that number will be one for each product described —and/or the number used or distributed. See separate instructions for examples of how to report under “developed or revised” and “used or distributed.”)

Products	Number developed or revised	Title/topic	Intended audience	Number used or distributed	Other languages
Brochures
Manuals
Newsletter
Posters
Promotional products (wallet cards, key rings, whistles, etc.)
Training materials (power point presentations, theatre scripts, etc.)
Training curricula
Web site (indicate the number of page views in the number used or distributed column)
Other (specify): _________________

C5. Data Collection and Communication Systems

W ere 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 or flagship project, responses in this section should reflect the aggregated responses of project members.)

• Yes--answer questions 36-37

• No--skip to C6

36. Use of Campus Program funds for data collection and/or communication systems (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

37. 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):

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 or flagship project, responses in this section should reflect the aggregated responses of project members.

• Yes--answer questions 38-39

• No--skip to Section D

38. 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): ____________________________

39. 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): __________________________

40. (Optional) Additional information (Use the space below to discuss the effectiveness of your system and capital improvements and to provide any additional information you would like to share beyond what you have provided about system and capital improvements in the data above. For example, if you have seen an increase in reporting as the result of funding interpreters or language lines you may provide that information here.)

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 or flagship project, responses in this section should reflect the aggregated responses of project members.)

• Yes--answer questions 41-48

• No—if no, please explain in box below, and then 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 was seeking or who received services during the current reporting period should be counted only once. For purposes of this question, victims/survivors are those against whom the sexual assault, domestic violence, dating 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. If you report victims/survivors as partially served or not served, please indicate reasons in the two tables below.)

	Sexual assault	Domestic violence/dating violence	Stalking	TOTAL
A. Served: Victims/survivors who received the service(s) they requested, if those services were funded by under your Campus Program grant
B. Partially served: Victims/survivors who received some service(s), but not all of the services they requested, if those services were funded by under your Campus Program grant
TOTAL SERVED AND PARTIALLY SERVED (41A+B)
C. Victims/survivors seeking services who were not served: Victims/survivors who sought service and did not receive the service(s) they were seeking, if those services were funded by 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
	Conflict of interest
	Did not meet statutory requirements
	Hours of operation
	Inadequate language capacity (including sign language)
	Insufficient/lack of culturally appropriate services
	Insufficient/lack of services for people with disabilities
	Lack of child care
	Program reached capacity
	Program rules not acceptable to victim/survivor
	Services inappropriate or inadequate for victims/survivors with substance abuse issues
	Services inappropriate or inadequate for victims/survivors with mental health issues
	Services not appropriate for victim/survivor
	Transportation
	Other (specify): _______________________________________________

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. Because victims/survivors may identify in more than one category of race/ethnicity, the total for “Race/Ethnicity” may exceed the total number of victims/survivors reported in 41A and 41B. However, the total number of victims/survivors reported under Race/Ethnicity should not be less than the total number of victims/survivors reported in 41A and 41B. The total number of victims/survivors reported under “Gender” and the total number reported under “Age” should equal the total number of victims/survivors reported in 41A and 41B. Those victims/suurvivors for whom gender, age, and/or race/ethnicity are not known should be reported in the “unknown” category.)

	Number of victims/survivors
Race/Ethnicity (victims/survivors should be counted once for each category of race/ethnicity that applies)
American Indian and Alaska Native
Asian
Black or African American
Hispanic or Latino
Native Hawaiian and other Pacific Islander
White
Unknown
TOTAL RACE/ETHNICITY(should not be less than the sum of, 41A and 41B)
Gender
Female
Male
Unknown
TOTAL GENDER(should equal the sum of 41A and 41B)
Age
0-12
13-17
18-24
25-59
60+
Unknown
TOTAL AGE(should equal the sum of 41A and 41B)
Other demographics
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 as served and partially served in 41A and 41B, report the victim/survivor’s relationship 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 total number of relationships in the sexual assault column must be at least [insert sum of sexual assault victims reported in 41A and 41B]; the total number in the domestic violence/dating violence column must be at least [insert sum of domestic violence victims reported in 41A and 41B]; and the total number in the stalking column must be at least [insert sum of stalking victims reported in 41A and 41B].

Victims/survivors’ relationship to offender	Number of victim/survivor relationships
	Sexual assault		Domestic violence/Dating violence	Stalking
Current or former spouse or intimate partner
Other family or household member
Acquaintance (neighbor, employee, co-worker,classmatestudentr, etc.)
Current or former dating relationship
Stranger
Relationship unknown
TOTAL

45. Victim services (Report the number of primary victims/survivors from 41A and 41B who received Campus Program-funded services. Count each victim/survivor only once for each type of service that the victim received during the current reporting period; do not report the number of times that service was provided to the victim. The total for each type of service should not be higher than the total of 41A and 41B [insert total of 41A and 41B.].

Type of service	Number of victims/survivors
Academic/Education advocacy (Actions designed to help the victim/survivor obtain needed support, resources, or services including assistance with course scheduling, academic letter of support, etc.)
Civil legal assistance (Civil legal services provided by an attorney and/or paralegal)
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 crisis intervention that occurs in person and/or over the telephone)
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)
Hospital/clinic response/other medical response (Accompanying a victim/survivor to, or meeting a victim/survivor at, a hospital, clinic, or medical office)
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)
Legal advocacy/Court accompaniment (Assisting a victim/survivor with legal issues including preparing paperwork such as victim impact statements, accompanying a victim/survivor to an administrative hearing, court proceeding, or law enforcement interview, and all other advocacy within the criminal or civil justice system. Services provided by an attorney and/or paralegal should be reported in civil legal assistance.)
Support group/Counseling services (Individual or group counseling or support provided by a volunteer, peer, or professional)
Transportation
Victim/survivor advocacy (Actions designed to assist the victim/survivor in obtaining support, resources, or services, including employment, health care, victim’s compensation, etc.)
Other (specify): _______________________________________________________

45A. Hotline/Information/Referral services (Report the number of hotline calls received from victims, and the total number of hotline calls received, during the current reporting period. Victims whose calls are reported here should not be reported as victims served in Question 41 unless they also received at least one of the services listed in Question 45 Victim Services. Victims who receive services such as crisis intervention or victim advocacy over the telephone should be reported in Question 45.)

Type of service	Number of calls from victims	Total number of calls
Hotline calls (Crisis or information and referral calls received by an agency’s hotline or office telephone.)

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	Total
On-campus
Off-campus
Total

47. (Optional) Additional information (Use the space below to discuss the effectiveness of your victim services and to provide any additional information you would like to share about your victim services activities beyond what you have provided in the data above. For example, if you have witnessed an increase in the number of victims/survivors who are able to remain in school and continue their education because of your academic and housing advocacy, you could report that here.)

4 8. 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. These orders may also be referred to as restraining orders, anti-harassment orders, or no-contact or stay-away orders.)

	Temporary protection orders	Final protection orders
Number of sexual assault protection orders requested
Number of sexual assault protection orders granted
Number of domestic violence protection orders requested
Number of domestic violence protection order granted
Number of stalking protection orders requested
Number of stalking protection orders granted

E . CAMPUS and COMMUNITY MEASURES

All grantees must complete this section. (If the grant funds a consortium or flagship project, responses in this section should reflect the aggregated responses of project 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 or flagship project, to the extent that the information is available. This applies to all sexual assault, domestic violence, dating violence, and stalking offenses, as defined by question 10, that occurred on campus, or in or on noncampus buildings or property, and on public property, 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, dating violence, and stalking.

49. Number of offenses reported (Report the number of sexual assault, domestic violence/dating violence, and/or stalking offenses reported to campus security authorities during the current reporting period.)

Type of offense	Number of offenses reported
Sexual assault
Domestic violence/ dating violence
Stalking
TOTAL

50. 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 ____________

51. 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			Sanctions
	Request of victim	Lack of evidence	Other	Reprimand	Suspension	Expulsion	Counseling	Community service	Other
Sexual assault
Domestic/dating violence
Stalking
TOTAL

52. (Optional) Additional information (Use the space below to discuss the effectiveness of your law enforcement and/or judicial and disciplinary board activities and to provide any additional information you would like to share about these activities beyond what you have provided in the data above.)

53. Dispositions of criminal charges in local jurisdiction (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				Number of deferred adjudications	Number convicted				Number acquitted
	Request of victim	Plea bargain	Lack of evidence	Other		Guilty of highest	Guilty of lesser	Plead as charged	Plead lesser
Sexual assault
Domestic/dating violence
Stalking
TOTAL

F. NARRATIVE

All grantees must answer question 54. (If the grant funds a consortium or flagship project, response to this question should reflect the aggregated responses of project members.)

Please limit your response to four pages for this question.

54. Report on the status of your Campus Program grant goals and objectives as of the end of the current reporting period. (Report succinctly 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 briefly 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 55and 56 on an annual basis. Submit this information on the January to June reporting form only. (If the grant funds a consortium or flagship project, responses to these questions should reflect the aggregated responses of project members.)

Please limit your response to two pages for each question.

55. What do you see as the most significant areas of remaining need, with regard to improving services to victims/survivors of sexual assault, domestic violence, dating violence and stalking, increasing victims/survivors safety, and enhancing community response (including offender accountability for both batterers and sex offenders? (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.)

56. What has Campus Program funding allowed you to do that you could not do prior to receiving this funding? (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 57 is optional.

Please limit your response to two pages for this question.

57. Provide additional information that you would like us to know about your Campus Program and/or the effectiveness of your grant. (If you have any other data or information that you have not already reported in answer to previous questions that demonstrate the effectiveness of your Campus Program-funded program, please provide it below. Refer to separate instructions for a fuller explanation and examples 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.)

58. Provide any additional information that you would like us to know about the data submitted. (If you have any information that could be helpful in understanding the data you have submitted in this report, please answer this question. For example, if you submitted two different progress reports for the same reporting period, you may explain how the data was apportioned to each report; or if you did not report staff or activities, you may explain why.)

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 7^th Street, NW, Washington, DC 20531.

20

Campus semiform 3-4-08