Form 1122-tba Semi-annual Progress report for the Grants to Indian Tri

DRAFT OMB Clearance # 1121-NNNN

Expiration Date

D epartment of Justice

Office on Violence Against Women

Semi-Annual Progress Report for

Grants to Indian Tribal Governments Program

Brief Instructions: This form must be completed for each Grants to Indian Tribal Governments (Tribal Governments Program) grant received. The grant administrator or coordinator must ensure that the form is completed fully with regard to all grant 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 supported under this grant during the current reporting period. Sections B, F, and subsections A1 and C3 of this form must be completed by all grantees. In sections D, E, and subsections A2, C1, C2, C4, C5, C6 and C7, grantees must answer an initial question about whether they supported certain activities during the current reporting period. If the response is yes, then the grantee must complete that section or subsection. If the response is no, the rest of that section or subsection is skipped.

For example, 1) if you are a victim services agency providing training and victim services with staff funded under this grant, you would complete A1, A2, B, C1, C3, D, and F (and answer ‘no’ in C2, C4, C5, C6, C7 and E1-E5); or, 2) if you are a law enforcement agency receiving funds to pay for staff who provide training to other law enforcement officers, you would complete A1, A2, B, C1, C3, and F (and answer ‘no’ in C2, C4, C5, C6, C7, D and E1-E5).

The activities of volunteers or interns should be reported if they were coordinated or supervised by Tribal Governments program-funded staff or if Tribal Governments 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

Section A: General Information 1

A1 Grant Information

A2 Staff Information

Section B: Purpose Areas 3

Section C: Function Areas 4

C1 Training 4

C2 Community Education 6

C3 Coordinated Community Response 8

C4 Policies 10

C5 Products and Codes 13

C6 Data Collection and Communication Systems 14

C7 System Improvement 15

Section D: Services to Victims and Families 16

D1 Victim Services/ Transitional Housing/Legal Services 16

D2 Supervised Visitation 26

Section E: Criminal Justice System 29

E1 Tribal Law Enforcement 29

E2 Tribal Prosecution 31

E3 Tribal Courts 33

E4 Tribal Probation 35

E5 Batterer Intervention Program (BIP) 37

Section F: Narrative 38

A. GENERAL INFORMATION

A1. Grant Information

All grantees must complete this section.

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 Tribal Governments Program grant): ______________

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

First Name MI Last Name

Address

City State Zip Code

Telephone Facsimile

E-mail

6. What tribal population(s) is(are) served by this grant?

7. What percentage of your Tribal Governments Program funds was directed to each of these areas? (Report the area[s] addressed by your Tribal Governments 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.)

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/survivor. 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. Stalking is defined as engaging in a course of conduct directed at a specific person that would cause a reasonable person to fear for his or her safety or the safety of others; or suffer substantial emotional distress.

(See separate instructions for more complete definitions).

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

A2. Staff Information

Were Tribal Governments Program funds used to fund staff positions during the current reporting period? Check yes if Tribal Governments Program funds were used to pay staff, including part-time staff and contractors.

• Yes--answer question 8.

• No--skip to Section B.

8. Staff (Report the total number of full-time equivalent (FTE) staff funded by the Tribal Governments Program grant during the current reporting period. Report staff by function(s) 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. Report grant-funded overtime. If an employee or contractor was employed or utilized for only a portion of the reporting period, prorate appropriately. Report all FTEs in decimals, not percentages. One FTE is equal to 1,040 hours—40 hours per week multiplied by 26 weeks. See separate instructions for examples of how to calculate FTEs.

Staff	FTEs
Administrator (fiscal manager, executive director, shelter manager)
Attorney (does not include prosecutor)
Batterer intervention program staff
Case manager
Child care worker
Counselor
Court personnel
Information technology staff
Judge
Law enforcement officer
Legal advocate (does not include attorney or paralegal)
Outreach staff
Paralegal
Probation officer/offender monitor
Program coordinator (CCR coordinator, training coordinator, victim services coordinator, transitional housing coordinator, visitation services coordinator)
Prosecutor
Sexual Assault Forensic Examiner/Sexual Assault Nurse Examiner (SAFE/SANE)
Security staff
Supervised visitation/exchange staff (visitation and exchange center)
Support staff (administrative assistant, bookkeeper, accountant )
Trainer/educator
Tribal cultural specialist
Victim advocate
Victim-witness specialist/coordinator
Other (specify):__________________
TOTAL

B. PURPOSE AREAS

All grantees must complete this section.

9. Statutory purpose areas (Check all purpose areas that apply to activities supported with Tribal Governments Program funds during the current reporting period.)

Check ALL that apply	Purpose areas
	Develop and enhance effective governmental strategies to curtail violent crimes against and increase the safety of Indian women consistent with tribal law and custom.
	Increase tribal capacity to respond to domestic violence/dating violence, sexual assault, and stalking crimes against Indian women.
	Strengthen tribal justice interventions including tribal law enforcement, prosecution, courts, probation, and correctional facilities.
	Enhance services to Indian women victimized by domestic violence/dating violence, sexual assault, and stalking.
	Work in cooperation with the community to develop education and prevention strategies directed toward issues of domestic violence/dating violence, and stalking programs and to address the needs of children exposed to domestic violence.
	Provide programs for supervised visitation and safe visitation exchange of children in situations involving domestic violence/dating violence, sexual assault, or stalking committed by one parent against the other with appropriate security measures, policies, and procedures to protect the safety of victims and their children.
	Provide transitional housing for victims of domestic violence/dating violence, sexual assault, or stalking, including rental or utilities payments assistance and assistance with related expenses such as security deposits and other costs incidental to relocation to transitional housing, and support services to enable a victim of domestic violence/dating violence, sexual assault, or stalking to locate and secure permanent housing and integrate into a community.
	Provide legal assistance necessary to provide effective aid to victims of domestic violence/dating violence, stalking, or sexual assault who are seeking relief in legal matters arising as a consequence of that abuse or violence, at minimal or no cost to victims.

C. FUNCTION AREAS

C1. Training

Were your Tribal Governments Program funds used for training during the current reporting period? Check yes if Tribal Governments Program-funded staff provided training or if Tribal Governments Program funds were used to directly support training.

• Yes--answer questions 10-13

• No--skip to C2

For purposes of this reporting form, training means providing information on sexual assault, domestic violence, dating violence, and stalking that enables professionals to improve their response to victims/survivors as it relates to their role in the system. Education means providing general information that will increase public awareness of sexual assault, domestic violence, dating violence and stalking. In this subsection, report information on training activities. Education should be reported in subsection C2.

10. Training events provided (Report the total number of training events provided during the current reporting period that were either provided by Tribal Governments Program-funded staff or directly supported by Tribal Governments Program funds. Training provided to Tribal Governments Program-funded staff should not be counted.)

Total number of training events provided

11. Number of people trained (Report the number of people trained during the current reporting period by Tribal Governments Program-funded staff or training supported by Tribal Governments Program funds by type of agency. Use the category that is most descriptive of the people who attended the training event. Tribal Governments Program-funded staff attending training events should not be counted. 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	Tribal	Non-tribal
Attorneys/law students (does not include prosecutors)
Batterer intervention/offender accountability program staff
Correction personnel (probation, parole, and correctional facility staff)
Court personnel (judges, clerks)
Disability organization staff (non-governmental)
Educational/child care staff (teachers, administrators, etc.)
Elder organization staff (non-governmental)
Faith-based organization staff
Federal law enforcement officers
Government agency staff (vocational rehabilitation, food stamps, TANF)
Health professionals (doctors, nurses-- does not include SAFE/SANE))
Law enforcement officers
Legal services staff (does not include attorneys)
Mental health professionals
Military command staff
Multidisciplinary (various disciplines at same training)
Prosecutors
Sexual Assault Forensic Examiners/Sexual Assault Nurse Examiner (SAFE/SANE)
Social service organization staff (non-governmental-- food bank, homeless shelter)
Spiritual leaders
Substance abuse treatment staff
Supervised visitation and exchange center staff
Tribal council members
Tribal elders
Tribal government/Tribal government agency staff
Victim advocates ( includes sexual assault, domestic violence, and dual)
Victim-witness specialist/coordinator
Volunteers
Women’s Advisory Committee members
Other (specify)
TOTAL

12. Training content areas (Indicate all topics covered in training events provided with your Tribal Governments Program funds during the current reporting period. Check all that apply.)

Sexual assault, domestic violence, dating violence and stalking

• Advocacy for American Indian and/or Alaska Native women

• Child witnesses

• Confidentiality

• Cultural issues specific to American Indians and/or Alaska Natives

• Dating violence overview, dynamics, and services

• Domestic violence overview, dynamics, and services

• Dynamics and history of violence against American Indian and/or Alaska Native women

• Historical trauma

• Indian Child Welfare Act

• Mandatory reporting requirements

• Response to victims who are incarcerated

• Safety planning for victims

• Sexual assault overview, dynamics, and services

• Stalking overview, dynamics, and services

• Supervised visitation and exchange

• Tribal strategies to address sexual assault, domestic violence/dating violence, or stalking

• Other (specify)

Other underserved populations

Issues specific to victims/survivors who:

• are elderly

• are geographically isolated

• are homeless or living in poverty

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

• have disabilities

• have mental health issues

• have substance abuse issues

• live in rural areas

• live in urban areas

• Other (specify):

Justice system

• Civil court procedures

• Criminal court procedures

• Dispatcher response

• Domestic violence statues/codes

• Firearms and domestic violence/dating violence

• Identification and arrest of predominant aggressor

• Judicial response

• Jurisdictional issues (local, tribal, federal, state)

• Law enforcement response

• Offender accountability programs/BIP

• Pro-arrest policies

• Probation response

• Prosecution response

• Protection orders (including full faith and credit)

• Sexual assault statutes/codes

• Sexual assault forensic examinations

• Stalking statutes/codes

• Tribal jurisdiction and Public Law 280

• Other (specify)

Community response

• Community response to sexual assault

• Coordinated community response

• Response teams (DART, DVRT, SART)

• Technology

• Volunteer training

• Other (specify):

13. (Optional) Additional Information (Use the space below to discuss the effectiveness of training activities

funded or supported by your Tribal Governments Program grant and to provide further explanation on

how these activities increase the safety of American Indian/Alaska Native women).

C2. Community Education

Were your Tribal Governments Program funds used for community education activities during the current reporting period? Check yes if any Tribal Governments Program-funded staff engaged in community education activities or if Tribal Governments Program funds directly supported community education.

• Y es--answer question 14-16.

• No--skip to SectionC3.

For purposes of this reporting form, education means providing general information that will increase public awareness of sexual assault, domestic violence, dating violence and stalking. Training means providing information on sexual assault, domestic violence, dating 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 community education activities. Training should be reported in subsection C1.

14. People educated with Tribal Governments Program funds (Report the number of people attending community education events during the current reporting period. Use the category that is most descriptive of the people who attended the event.)

People attending event	Number
Child care providers
Community businesses (casinos, retail stores)
Community groups (service or social groups)
Community members
Educators (teachers, administrators, etc.)
Faith-based groups
Men’s groups
Parents/guardians
Students
Tribal elders
Victims/survivors
Women’s groups
Other (specify)
Total

1 5. Topics of education events provided with Tribal Governments Program funds (Indicate all topics covered in education events provided with your Tribal Governments Program funds during the current reporting period. Check all that apply).

Domestic violence/dating violence

• Child witness overview, dynamics and services

• Dating violence overview, dynamics and services

• Domestic violence/dating violence prevention program

• Domestic violence overview, dynamics and services

• Healthy relationships/Domestic violence/dating violence prevention (6-12th grade)

• Healthy relationships/Domestic violence/dating violence prevention (university)

• Healthy relationships/Domestic violence/dating violence prevention (community)

• Indigenous prevention programs

• Mandated reporting of child victimization

• Response to victims who are incarcerated

• Safety planning

• Sexual assault overview, dynamics, and services

• Stalking overview, dynamics, and services

• Youth awareness of sexual assault, domestic violence/dating violence, and stalking

• Workplace violence

• Other (specify):

How to help American Indian or Alaska Native victims/survivors who:

• are elderly

• are geographically isolated

• are homeless or living in poverty

• are isolated or institutionalized

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

• have disabilities

• have mental health issues

• have substance abuse issues

• live in rural areas

• live in urban areas

• Other (specify):

16. Outreach activities (Indicate the number of outreach activities supported with Tribal Governments Program funds during the current reporting period.)

Activities	Number
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): _____________________________________________
Total events

C3. Coordinated Community Response

All grantees must complete this section.

Are you an Indian victim services provider organization?

• Y es

• No

Are you a Tribal Coalition?

• Y es

• No

17. Coordinated community response activities Check the appropriate boxes to indicate the agencies or organizations that you provided victim/survivor referrals to, received victim/survivor referrals from, engaged in consultation with, provided technical assistance to, and/or attended meetings with, during the current reporting period, 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 agencies or organizations with which you have a mandatory collaboration for purposes of your Tribal Governments Program grant. If Tribal Governments 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.)

Agencies or groups	Victim/survivor referrals, consultations, technical assistance			Meetings			Collaborative Partners
	Daily	Weekly	Monthly	Weekly	Monthly	Quarterly
Non-profit, non-governmental Indian victim services program							
Non-profit, tribal domestic violence/dating violence or sexual assault coalition							
Women’s advisory committee							
Batterer intervention/offender monitor program						
Community advocacy organization						
Corrections (probation, parole and correctional facility staff)						
Court (federal)						
Court (state or local)						
Court (tribal)						
Educational Institutions/Youth Programs						
Faith-based organization						
Health/mental health organization						
Law enforcement (federal)						
Law enforcement (local or state)						
Law enforcement (tribal)						
Legal organization (legal services, bar association, law school)						
Prosecutor (federal)						
Prosecutor (tribal)						
Prosecutor (local or state)						
Social service organization						
Tribal council						
Tribal elders						
Tribal government agency						
Tribal housing authority						
Other (specify)						

18. (Optional) Additional information Use the space below to discuss the effectiveness of coordinated community response activities funded by your Tribal Governments Program grant and to provide further explanation on how these activities increase the safety of American Indian/Alaska Native women.

C4. Policies

Were your Tribal Governments Program funds used to develop, substantially revise or implement policies or protocols during the current reporting period? Check yes if Tribal Governments Program-funded staff developed, substantially revised, or implemented policies or protocols, or if Tribal Governments Program funds directly supported the development, revision or implementation of policies, protocols.

• Yes--answer question 19

• No--skip to C5

19. Types of policies or protocols developed, revised, or implemented during the current reporting period. (Check all that apply.)

Victim services

• Appropriate response to victim/survivors with substance abuse issues and /or mental health diagnoses

• Appropriate services for victims/survivors who are American Indian or Alaska Native

• Appropriate services for victims who are elderly or have disabilities

• Confidentiality

• Mandatory training standards for staff and volunteers

• Procedures for anonymous, confidential, or Jane Doe reporting of sexual assault

• Victim/survivor informed about Crime Victim’s Compensation and Victim Impact Statements

• Other (specify): ________________

Health care

• Advocate response to emergency room

• Appropriate response to victims to avoid or eliminate re-traumatization

• Appropriate services for victims/survivors who are American Indian or Alaska Native

• Appropriate services for victims/survivors are who are elderly or have disabilities

• Forensic exams not billed to victim

• Mandatory training on sexual assault, domestic violence/dating violence, and/or stalking

• Routine screening and referrals for sexual assault, domestic violence/dating violence, and/or stalking

• Other (specify): _______________

Law enforcement

• Appropriate response to other underserved populations

• Appropriate response to victims/survivors who are American Indian or Alaska Native

• Appropriate response to victims who are elderly or have disabilities

• Identifying primary aggressor/discouraging dual arrest

• Immediate access to protection order information

• Mandatory training on sexual assault, domestic violence/dating violence, and/or stalking

• No charge to sexual assault victim/survivor for any cost associated with forensic exam

• No charge to victims/survivors for any costs related to the prosecution of sexual assault, domestic violence/dating violence, and/or stalking

• No charge to victims/survivors for service of protection orders, warrants, or subpoenas

• No victims polygraphed

• Procedures for anonymous, confidential, or Jane Doe reporting of sexual assault

• Protection order enforcement (including full faith and credit)

• Providing information to victims/survivors about victim services

• Report writing and investigation guidelines

• Sexual assault response and protocols

• Stalking response and protocols

• Other (specify): ________________

Prosecution

• Appropriate response to other underserved populations

• Appropriate response to victims/survivors who are American Indian or Alaska Native

• Appropriate response to victims who are elderly or have disabilities

• Child witness strategies

• Evidence-based prosecution

• Protection order enforcement (including full faith and credit)

• Mandatory training on sexual assault, domestic violence/dating violence, and/or stalking

• No charge to victim/survivors for any costs related to the prosecution of sexual assault, domestic violence/dating violence and/or stalking

• No victims polygraphed

• Sexual assault response and protocols

• Stalking response and protocols

• Victim witness notification

• Other (specify): ________________

Court

• Accelerated trial schedules

• Appropriate response to other underserved populations

• Appropriate response to victims/survivors who are American Indian or Alaska Native

• Appropriate response to victims who are elderly or have disabilities

• Full faith and credit for protection orders

• Judicial monitoring of sexual assault, domestic violence/dating violence and/or stalking offenders

• Mandatory training on sexual assault, domestic violence/dating violence, and/or stalking

• No charge to victim/survivors for any costs related to the prosecution of sexual assault, domestic violence/dating violence and/or stalking

• Policy against mediation

• Policy against mutual restraining orders

• Procedures for courtroom security

• Other (specify): ________________

Probation and parole

• Appropriate response to victims/survivors who are American Indian or Alaska Native

• Appropriate response to victims/survivors from other underserved populations

• Appropriate response to victims/survivors who are elderly or have disabilities

• Mandatory training on sexual assault, domestic violence/dating violence, and/or stalking

• Strategies to assist and protect victim/survivor during probation and parole

• Victim notification

• Other (specify): ________________

CCR

• Interagency Response

Supervised Visitation and Exchange Policies

Center operations

• Confidentiality

• Flexible hours of operation

• Income-based fees (sliding scale)

• Program does not charge fees

• Protocol between advocacy organization and supervised visitation program

• Recordkeeping and report writing

• Other (specify):

Service provision

• Appropriate response to underserved populations

• Child-friendly (toys, games, appropriate décor)

• Court feedback procedures

• Courtesy monitoring

• Document exchange procedures

• Mandatory training on domestic violence/dating violence, sexual assault, child abuse, and stalking

• Out-of-jurisdiction referrals

• Supervised exchange procedures

• Other (specify): _____________________________

Security and safety

• Different entrances for parties

• Escort for children and custodial parent

• Metal detectors

• Panic button(s)

• Private, secure drop-off locations for children

• Private, secure entrances for children and custodial parent

• Security guards

• Security measures in place (cameras, staff, etc.)

• Security staff observations

• Staggered arrival/departure times

• Other (specify):

20. (Optional) Additional information (Use the space below to discuss the effectiveness of policies funded or supported by your Tribal Governments Program grant that you have developed or implemented and to provide further explanation on how these policies increase the safety of American Indian/Alaska Native women.)

C5. Products and Codes

W ere your Tribal Governments Program funds used to develop, substantially revise, or distribute products or codes during the current reporting period? Check yes if Tribal Governments Program-funded staff developed, revised and/or distributed products or codes or if Tribal Governments Program funds directly supported the development, revision, or distribution of products or codes.

• Yes--answer question 21

• No--skip to C6

21. Use of Tribal Governments Program funds for product or code development, substantial revision, or distribution (Report the number of products or codes developed, substantially revised, or distributed with Tribal Governments Program funds during the current reporting period. Report the number of new products or codes developed or substantially revised during the current reporting period; the title/topic; the intended audience for each product or code developed, revised, or distributed; and the number of products or codes used or distributed. If a product or code was created in or translated into a language other than English, including Braille, indicate the language. Report on products or codes that were newly developed during the current reporting period whether or not they were used or distributed, and on products or codes that were previously developed or revised but were 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
Training curricula
Training materials
Tribal codes
Other (specify): ________

C6. Data Collection and Communication Systems

Were your Tribal Governments 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 Tribal Governments Program funds or Tribal Governments Program-funded staff were used to develop, install, or expand data collection and/or communication systems.

• Yes--answer questions 22-23

• No--skip to C7

22. Use of Tribal Governments Program funds for data collection and/or communication systems (Check all that apply.)

• Develop new data collection/communication systems

• Install data collection/communication systems

• Expand existing data collection/communication systems

• Link existing data collection/communication systems

• Share information with other community partners

• Manage data collection and communication

• Purchase computers and other equipment

23. Purpose of data collection and/or communication systems (Indicate all types of information being identified or tracked with this technology by checking all that apply.)

• Arrests/charges

• Bail/bond orders

• Calls to police

• Case management

• Compliance with court-ordered sanctions

• Convictions

• Court docket management

• Evaluation/outcome measures

• Incident reports

• Information sharing

• Probation conditions/violations

• Prosecutions

• Protection orders

• Recidivism

• Sentencing

• Sex offender registration

• Stalking and harassment orders

• Victim notification

• Victim service availability

• Violations of protection orders

• Warrants

• Other (specify): _____________________

C7. System Improvement

Were your Tribal Governments Program funds used for system improvement during the current reporting period? Check yes if any Tribal Governments Program-funded staff engaged in system improvement activities or if Tribal Governments Program funds directly supported system improvements (e.g., safety audits, security).

• Y es--answer question 24

• No--skip to Section D

24. Use of Tribal Governments Program funds for system improvement (Check all that apply for the current reporting period.)

	Victim services	Law enforcement	Prosecution	Court	Probation or parole/offender monitoring
Meetings between tribal and non-tribal entities
Safety and accountability audits
Security personnel or equipment
Translation of forms and documents
Other (specify):__________

D 1. VICTIM SERVICES/LEGAL SERVICES/TRANSITIONAL HOUSING SERVICES

Were your Tribal Governments Program funds used to provide victim services, legal services, and/or transitional housing services to victims/survivors during the current reporting period? Check yes if Tribal Governments Program-funded staff provided any of these victim services or if Tribal Governments Program funds were used to support any of these victim services during the current reporting period. Report all victims served, and services provided with Tribal Governments Program funds, whether by a victim services agency, a legal services organization, or by staff providing victim services within law enforcement, prosecution, or the court system in Section D1. Report supervised visitation and exchange services in Section D2 only. Report criminal justice activities, such as 911 calls, cases investigated, and cases prosecuted in Section E only.

• Yes--answer questions 25-36.

• No--skip to Section D2.

25. Number of victims/survivors served, partially served, and victims 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 in that reporting period. 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 experienced more than one victimization, that person should be counted only once under the primary victimization. Do not report secondary victims here.)

	Number of victims/survivors
	Sexual assault	Domestic violence/ dating violence	Stalking	Total
A. Served: Victims/survivors who received the grant-funded service(s) they requested, if those services were funded by your Tribal Governments Program grant.
B. Partially served: Victims/survivors who received some grant-funded service(s), but not all of the grant-funded services they requested, if those services were funded by your Tribal Governments Program grant.
TOTAL SERVED and PARTIALLY SERVED (25A + 25B)
C. Victims/survivors seeking services who were not served: Victims/survivors who sought grant-funded services and did not receive the grant-funded service(s) they were seeking, if those services are funded by your Tribal Governments Program grant.

26. 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
	Jurisdictional Issues
	Lack of child care
	Program reached capacity
	Program rules not acceptable to victim/survivor
	Program unable to provide service due to limited resources/priority-setting
	Services inappropriate or inadequate for victims/survivors with mental health issues
	Services inappropriate or inadequate for victims/survivors with substance abuse issues
	Services not appropriate for victim/survivor
	Services not available for victim/survivor accompanied by male adolescents
	Transportation problems
	Other (specify):

27. Demographics of victims/survivors served or partially served (Based on the victims/survivors reported in 25A and 25B, report the total numbers for all demographic categories 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 25A and 25B. However, the total number of victims/survivors reported under Race/Ethnicity should not be less than the total number of victims/survivors reported in 25A and 25B. 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 25A and 25B. Those victims for whom gender, age, and/or race/ethnicity is not known should be reported in the “unknown” category. Do not report demographics for children.)

	Victims/survivors
Race/Ethnicity ((victims/survivors should be counted once in each category of race/ethnicity that applies.)
American Indian and/or 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 25A and 25B)
Gender
Female
Male
Unknown
TOTAL GENDER (should equal the sum of 25A and 25B)
Age
0-12
13-17
18-24
25-59
60 +
Unknown
TOTAL AGE(should equal the sum of 25A and 25B)
Other Demographics
People with disabilities
People with limited English proficiency
People who live in rural areas

28. Victims/survivors’ relationships to offenders (For those victims/survivors reported as served and partially served in questions 25A and 25B, 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 25A and 25B]; the total number in the domestic violence/dating violence column must be at least [insert sum of domestic violence victims reported in 25A and 25B]; and the total number in the stalking column must be at least [insert sum of stalking victims reported in 25A and 25B. Do not report relationships to offender for children.)

Victim’s 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
Dating relationship
Acquaintance (neighbor, employee, co-worker, student, schoolmate, etc.)
Stranger
Relationship unknown
TOTAL

29. Number of services provided to children of victims (Report the number of children of victims/survivors reported as served or partially served in question 25A& 25B who also received services and the number of times the services were provided during the current reporting period. Do not report demographic information in question 27 for the children served.)

	Number of children	Number of times service was provided
Children’s services (refers to services provided to children of victims, including child care, transportation, counseling, etc.)

30A. Victim services (Report the number of victims/survivors from 25A and 25B who received Tribal Governments Program-funded services during the current reporting period Count each victim/survivor only once for each type of service that victim received during the current reporting period in the column for the number of victims/survivors and report the number of times that services was provided to the victim/survivor. The total for each type of service should not be higher in the number of victims/survivors column than the total of 25A and 25B [insert total of 25A and 25B.] Transitional housing and shelter services should be reported in questions 32-34. Do not report children receiving services in this question.)

Type of service	Number of victims/survivors	Number of times service was provided
Civil legal advocacy/court accompaniment (Assisting a victim/survivor with civil legal issues, including preparing paperwork for protection orders; accompanying a victim/survivor to a protection order hearing, administrative hearing, or other civil proceeding; and all other advocacy within the civil justice system. Does not include services provided by an attorney or paralegal.)
Counseling services/support group (Individual or group counseling or support provided by a volunteer, peer, or professional.)
Criminal justice advocacy/court accompaniment (Assisting a victim/survivor with criminal legal issues including notifying the victim/survivor of case status, hearing dates, plea agreements, and sentencing terms; preparing paperwork such as victim impact statements; accompanying a victim/survivor to a criminal court proceeding or law enforcement interview; and all other advocacy within the criminal justice system.)
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.)
Cultural advocacy (Activities such as sweat lodge, talking circles, wellness gatherings, cultural ceremonies, etc.)
Forensic exam
Hospital/clinic/medical response (Accompanying a victim/survivor to or meeting a victim/survivor at the hospital , clinic., or medical office)
Transportation
Victim/survivor advocacy (Actions designed to assist the victim/survivor in obtaining support, resources or services including employment, housing, shelter services, health care, victim’s compensation, etc.)
Other (specify) ____________________________________________

30B. Hotline calls (Report the number of hotline calls received on phone lines paid for with Tribal Government Program funds or answered by Tribal Governments Program-funded staff during the current reporting period. Calls reported here should not be reported as victims served in question 25 unless they also received at least one of the services listen in Question 30A Victim Services or Question 32-34 Shelter Services/Transitional Housing Assistance.)

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

30C. Victim witness notification/outreach to victims (Report the number of unsolicited letters, phone calls, or visits to victims of specific incidents of sexual assault, domestic violence/dating violence, and stalking incidents identified in police reports or court documents, informing them of services and/or providing information about the criminal justice system. Victims who are the recipients of these notification/outreach activities should not be reported as victims served in Question 25 unless they also received at least one of the services reported in Question 30A Victim Services or Questions 32-34, Shelter Services/Transitional Housing Assistance.)

Type of service	Number of notification/outreach activities to victims
Victim witness notification/outreach to victims (unsolicited letters, phone calls or visits)

31. Protection orders (Report the total number of temporary and/or final protection orders requested and granted for

which Tribal Governments Program-funded victim services staff provided assistance to victims/survivors during the

current reporting period. These orders may also be referred to as protection from abuse, protection from harassment or

anti-harassment orders, restraining orders, or no-contact or stay-away orders.)

	Temporary protection orders	Final protection orders
Number of protection orders requested
Number of protection orders granted

Shelter/Transitional Housing Assistance

Were your Tribal Governments Program funds used to provide shelter and/or transitional housing assistance to victims/survivors during the current reporting period? Check yes if Tribal Governments Program-funded staff provided any of these services or if Tribal Governments Program funds were used to support any of these services during the current reporting period.

• Yes--answer questions 32-34.

• No--skip to Section D2.

32. Shelter and transitional housing services (Report the total number of victims/survivors and accompanying family members who received emergency shelter or transitional housing provided with Tribal Governments Program funds during the current reporting period. This should be an unduplicated count for both victims/survivors and for family members. This means that each victim/survivor and each family member who received shelter services during the current reporting period should be counted only once. Report the total number of bed nights provided in emergency shelter or transitional housing to victims/survivors and family members. Emergency shelter can be safe houses or hotel motel accommodations. The number of bed nights is determined by multiplying the number of victims and family members by the number of nights they stayed in the shelter. The number of bed nights will typically be significantly higher than the number of victims and family members. For example, one victim and her three children all stayed in the shelter for 10 nights. The number of bed nights would be 4 multiplied by 10, or 40.)

Shelter service	Number of victims/survivors	Number of family members	Number of bed nights
Emergency shelter
Transitional housing

33. Type and number of housing units (Report the number and type of housing units supported with grant funds.

Section B, number of units, should be an unduplicated count of the units available. See the separate set of

instructions for definitions.)

	A. Number of units/subsidies			B. Number of single/family units
Type of housing units	Tribal/Program-owned units	Program-rented units	Vouchers/ rent subsidies	Available to families	Available to single victims/survivors
Scattered
Clustered
Co-located with domestic violence/dating violence emergency shelter
Co-located with homeless emergency shelter
Other (specify)
TOTAL

34. Housing Assistance (For those victims/survivors reported in 25A and 25B, report the number provided with each of type of housing assistance during the current reporting period. Each person may be counted once for each type of housing assistance they received during the current reporting period. See separate set of instructions for examples.)

Type of service	Total cost	Number of victims/survivors	Total number of months
Childcare
Clothing
Food
Household furnishings (purchased with grant funds)
Rent subsidy
Relocation expenses
Rental unit fees (security deposit, application fees, credit report fees)
Transportation
Utilities (including electricity, heat and telephone)
Other (specify): ___________________________
TOTAL

L EGAL SERVICES

Were your Tribal Governments Program funds used to provide legal services to victims/survivors during the current reporting period? Check yes if Tribal Governments Program-funded staff provided any of these services or if Tribal Governments Program funds were used to support any of these services during the current reporting period.

• Yes--answer questions 35-37.

• No--skip to Section D2.

Answer Questions 35-37 only if your Tribal Governments Program funds supported lawyers, paralegals, or specially appointed advocates who provided legal services to victims/survivors during the current reporting period.

35. Legal issues (Report the total number of new and pending matters in which the following legal issues were addressed

by Tribal Governments Program-funded lawyers, paralegals, or specially appointed advocates during the current

reporting period. Count a victim/survivor once for each category of legal issue for which they received assistance. A

pending matter is one that was open as of the first day of the current reporting period; a new matter is one that was

opened during the current reporting period.)

Legal issues	Number of victims/survivors
	Pending	New
A. Protection orders (temporary and final, enforcement of existing PO)
B. Family law matters
Divorce
Custody/visitation
Establishment of paternity
Child/spousal support
Other family law matters
C. Consumer/finance (credit, debt, bankruptcy, tax, etc.)
D. Employment
E. Income maintenance (TANF, disability, food stamps, unemployment)
F. Housing
G. Victims’ rights within the criminal justice system (Does not include defending victims accused of criminal activities.)
H. Other (specify): _____________________________

35A. Number of victims/survivors who received assistance with legal issues in question 35 (Report an unduplicated

count for the number of victims/survivors who received assistance with at least one legal issue in question 35. If they

received assistance with more than one legal issue, count them only once in this question and report them below in

question 36.)

36. Number of victims/survivors who received assistance with multiple legal issues (Report the number of victims/survivors who received Tribal Governments Program-funded services in more than one of the categories [A-H] listed in question 35 during the current reporting period. Consider all family law matters as one category.) ______

37. Legal outcomes (For all cases closed or issues resolved during the current reporting period for which services were provided by Tribal Governments Program-funded lawyers, paralegals, or lay legal advocates, report the number and type of outcome for each issue addressed and resolved. Include all outcomes in all matters.)

Legal issue	Information/ referral/ advice only	Brief services	Administrative decision	Court decision	Negotiated resolution		Victim/ survivor withdrew	Other result
					Filed action	No filed action
Protection orders (temporary and final, enforcement of existing PO)
Divorce
Custody/visitation
Establishment of paternity
Child/spousal support
Other family law matters
Consumer/finance (credit, debt, bankruptcy, tax, etc.)
Employment
Income maintenance (TANF, disability, food stamps, unemployment)
Housing
Victims’ rights in criminal justice system (Does not include defending victims accused of criminal activities.)
Other (specify): ______________

D2. SUPERVISED VISITATION

W ere your Tribal Governments Program funds used to provide supervised visitation and/or exchange services to families during the current reporting period? Check yes if Tribal Governments Program-funded staff provided supervised visitation and/or exchange services during the current reporting period.

• Yes--answer questions 38-44. Provide information only on families served with Tribal Governments Program grant funds.

• No--skip to Section E

38. Number of families served, partially served, and families seeking services who were not served Please do not attempt to answer this question without referring to the separate set of 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 family who were seeking or who received services during the current reporting period should be counted only once in that reporting period.

	Number of families
A. Served: Families who received the grant-funded service(s) they requested, if those services were funded by your Tribal Governments Program grant.
B. Partially served: Families who received some grant-funded service(s), but not all of the grant-funded services they requested, if those services were funded by your Tribal Governments Program grant.
TOTAL SERVED AND PARTIALLY SERVED (38A + 38B)
C. Families seeking services who were not served: Families who sought grant-funded services and did not receive the grant-funded service(s) they requested, if those services were funded by your Tribal Governments Program grant.

39. Reasons families seeking services were not served or were partially served (Check all that apply.)

	Reasons not served or partially served
	Hours of operation
	Inadequate language capacity (including sign language)
	Insufficient/lack of culturally appropriate services
	Insufficient/lack of services for people with disabilities
	Party(ies) not accepted into program
	Program reached capacity
	Program rules not acceptable to party(ies)
	Services inappropriate or inadequate for people with mental health issues
	Services inappropriate or inadequate for people with substance abuse issues
	Services not appropriate for party(ies)
	Transportation problems
	Other (specify): ______________________________________________________

3 9A. Number of families not accepted into program and reasons (Report the total number of families who were not accepted into the program during the current reporting period by the reason they were not accepted.)

Reason	Number of families declined
Too dangerous
Conflict of interest
Client unwilling to agree with program rules
Other (specify): ____________________________
Total

40. Demographics of family members served or partially served (Based on the families reported in 38A and 38B, report the total numbers for all demographic categories that apply. Report the numbers of parents and children served and partially-served. These numbers should be based on the individuals in the families counted in question 38A and 38B. This should be an unduplicated count for “gender” and “age”. Parents and children may identify in more than one category for race/ethnicity, however they may not be counted more than once in each individual category of race/ethnicity. Those victims for whom gender, age, and/or race/ethnicity is not known should be reported in the “unknown” category.)

	Custodial parents	Non-custodial parents	Children
Race/ethnicity (Individuals may be counted for each 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
Gender
Female
Male
Unknown
TOTAL GENDER
Age
0 to 6
7 to 12
13 to 17
18 to 24
25 to 59
60+
Unknown
TOTAL AGE
Other demographics
People with disabilities
People with limited English proficiency
People who live in rural areas

4 1. Number of families by primary victimization and referral source (Report the number of families by primary type of victimization and referral source. This is an unduplicated count and each family should only be counted once. This should equal the sum of 38A and 38B. Refer to the separate set of instructions for further explanation and examples.)

	Total number of families	Sexual assault	Domestic violence/dating violence	Stalking
Referral Source
Criminal court order
Family court order
Juvenile court order
Protection order
Other civil court order
Other (specify): ________
TOTAL

42. Services provided with Tribal Governments Program funds (Report the number of families receiving each of these services and the number of times the services were provided during the current reporting period. See separate instructions for examples and for the definition of therapeutic supervision.)

Type of service	Number of families	Number of times services provided
Group supervision
One-to-one supervision
Supervised exchange
Telephone monitoring
Other (specify): __________

43. Services terminated or completed (Report the number of families whose services were terminated or completed during the current reporting period. Check the primary reason.)

Reason terminated or completed	Number of families
Cessation of threats/use of violence
Change in court order
Child refuses to participate
Deceased
Habitual non-compliance with program rules
Habitual no-shows or cancellations
Incarcerated
Moved/relocated
Mutual agreement of both parties
Parent completed treatment program
Supervisor's discretion
Unknown
Other (specify): _______________________
TOTAL

44. (Optional) Additional information (Use the space below to discuss the effectiveness of victim services, shelter/transitional housing, legal services, and supervised visitation activities funded or supported by your Tribal Governments Program grant and to provide further explanation on how these activities increase the safety of American Indian/Alaska Native women.)

E. CRIMINAL JUSTICE SYSTEM

E1. Tribal Law Enforcement

Were your Tribal Governments Program funds used for Tribal law enforcement activities during the current reporting period? Check yes if Tribal Governments Program funded law enforcement activities. If Tribal Governments Program funds supported only a victim-witness assistant or victim advocate located in a law enforcement agency, then only Section D Victim Services should be completed.

• Yes--answer questions 45-48. Provide information only for Tribal Governments Program-funded law enforcement activities engaged in during the current reporting period.

• No--skip to E2

45. Activities (Report the number of Tribal Governments Program-funded activities on sexual assault, domestic violence/dating violence, and stalking cases/incidents for the current reporting period.)

Activity	Sexual assault	Domestic violence/dating violence	Stalking
Calls for assistance (All 911 and other calls made to law enforcement.)
Incident reports (All responses to an incident as reported on an incident report.)
Cases/incidents investigated (All cases in which evidence was collected/witnesses interviewed relating to an incident.)
Forensic medical evidence (All cases in which rape kits were processed
Arrests (All arrests made by law enforcement, except dual arrests.)
Dual arrests (Responses by law enforcement in which the two parties involved in the incident are arrested.)
Protection/ex parte/temporary restraining orders served (All instances in which these types of orders were served on offenders.)
Arrests for violation of bail bond (All instances in which arrests were made of offenders who violated conditions set out in their bail bonds.)
Enforcement of warrants (All Instances in which warrants relating to these incidents were enforced.)
Arrests for violation of protection order
Protection orders issued (All orders directly issued by law enforcement, in jurisdictions where law enforcement officers are so authorized.)
Cases referred to tribal prosecutors
Cases referred to local or state law enforcement or prosecutors
Cases referred to federal law enforcement or prosecutors (Not including federal firearms charges)
Referrals of federal firearms charges to federal prosecutor

46. Victims referred to victim services (Report the total number of victims who were referred to victim services by Tribal Governments Program-funded staff during the current reporting period. Victim services refer to services provided by agencies that serve victims of sexual assault, domestic violence/dating violence, and/or stalking.)

	Tribal victim services	Non-tribal victim services
Number of victims

47. Protection orders (Report the total number of temporary and/or final protection orders requested and granted for which Tribal Governments Program-funded law enforcement staff provided assistance to victims/survivors during the current reporting period. These orders may also be referred to as protection from abuse, protection from harassment or

anti-harassment orders, restraining orders, or no-contact or stay-away orders.)

	Temporary protection orders	Final protection orders
Number of protection orders requested
Number of protection orders granted

48. (Optional) Additional information (Use the space below to discuss the effectiveness of law enforcement activities funded or supported by your Tribal Governments Program grant and to provide further explanation on how these activities increase the safety of American Indian/Alaska Native women.

E2. Tribal Prosecution

Were your Tribal Governments Program grant funds used for tribal prosecution during the current reporting period? Check yes if Tribal Governments Program funded prosecution activities. If Tribal Governments funds supported only a victim-witness assistant/specialist or victim advocate located in a prosecution office, then only Section D Victim Services should be completed.

• Yes--answer questions 49-54. Provide the information only for Tribal Governments Program-funded

prosecution activities engaged in during the current reporting period.

• No--skip to E3

49. Number of cases received, accepted for prosecution, or declined (Report the number of domestic violence, sexual assault, or stalking-related case referrals received--including cases already charged before reaching the prosecutor’s office—and of those cases referred, report the number that were accepted and the number that were declined for prosecution during the current reporting period. A case should be characterized by the most serious offense and may include numerous charges or counts. In most instances, a case will refer to one victim, one offender, and one incident. It is strongly suggested that you refer to the separate instructions for examples of how to count and characterize cases.)

Domestic violence cases may include any assaults, battery, vandalism, or other offenses that occurred in a domestic violence incident. Your tribal code does not have to name an offense ‘‘domestic violence’’ for a case addressing that offense to be counted here. Similarly, cases addressing sexual assault, dating violence and stalking offenses should be counted, even if your tribal code uses other names for these types of offenses, such as ‘‘sexual battery’’ or ‘‘harassment.’’

Received/accepted/declined	Domestic violence/dating violence	Sexual assault	Stalking
a. Number of case referrals received
b. Number of cases accepted for prosecution
c. Number of cases declined
d. Number of cases declined due to jurisdictional limitations
d1. Cases referred to local, state, or federal entity for prosecution
d2. Cases not referred to local, state, or federal entity for prosecution

49A. Reasons for declining cases (Of those cases reported in 49c as declined and 49d2 as not referred, report only the

primary reason for the decision to decline or not refer for prosecution. Please see separate instructions for further

explanation of the reasons and for examples of how to apply them.)

Reason for declining	Domestic violence/dating violence	Sexual assault	Stalking
Insufficient evidence (returned for further investigation)
Insufficient evidence/victim unavailable
Request of victim/victim safety
Other

50. Disposition of cases (Report the dispositions of all cases resolved during the current reporting period.)

Type of case	Number dismissed	Number of deferred adjudications	Number convicted				Number acquitted
			Guilty as charged	Guilty of lesser	Plead as charged	Plead to lesser
Sexual assault
Domestic violence/dating violence
Stalking
Violation of protection order
Violation of bail
Violation of probation
Violation of other court order
Other (specify): _________________

51. (Optional) Other issues present in cases that reached disposition (If possible, use the space below to discuss the extent to which cases that were characterized as domestic violence/dating violence, sexual assault, and/or stalking also included additional charges or elements of domestic violence/dating violence, sexual assault, and/or stalking beyond that case characterization. For example, cases reported above as domestic violence cases may also have included counts of sexual assault, and cases reported as sexual assaults may also have included stalking charges. The purpose of this question is to gather information on how often multiple crimes were present in the cases reported. If detailed information is not available, feel free to provide estimates based on your experience.)

52. Victims referred to victim services (Report the total number of victims who were referred to victim services by Tribal Governments Program-funded staff during the current reporting period. Victim services refer to services provided by agencies that serve victims of sexual assault, domestic violence/ dating violence, and/or stalking.)

	Tribal victim services	Non-tribal victim services
Number of victims

53. Protection orders (Report the total number of temporary and/or final protection orders requested and granted for which Tribal Governments Program-funded tribal prosecutors provided assistance to victims/survivors during the current reporting period. These orders may also be referred to as protection from abuse, protection from harassment or

anti-harassment orders, restraining orders, or no-contact or stay-away orders)

	Temporary protection orders	Final protection orders
Number of protection orders requested
Number of protection orders granted

54. (Optional) Additional information (Use the space below to discuss the effectiveness of prosecution

activities funded or supported by your Tribal Governments Program grant and to provide further explanation on how

these activities increase the safety of American Indian/Alaska Native women.

E3. Tribal Courts

Were your Tribal Governments Program funds used for tribal courts during the current reporting period? Check yes if Tribal Governments Program funds directly supported court activities. If Tribal Governments funds supported only a victim advocate located in a court, then only Section D Victim Services would be completed.

• Yes--answer questions 55-62. Provide the information only for Tribal Governments Program-funded court activities engaged in during the current reporting period.

• No--skip to E4

55. Number of criminal cases (Report the total number of new sexual assault, domestic violence/dating violence and stalking-related cases filed during the current reporting period.)

Your tribal code or state law does not have to name the offense “sexual assault”, “domestic violence/dating violence” or “stalking” for it to be counted here. Your code may use other names for these types of offenses, such as sexual battery or harassment. Similarly, domestic violence/dating violence offenses include any assaults, battery, vandalism, or other offenses that occurred in a domestic violence/dating violence incident.

Type of case	New cases filed during the current reporting period
Sexual assault
Domestic violence/dating violence
Stalking
Violation of protection order
Violation of bail
Violation of probation
Violation of other court order
TOTAL

56. Disposition of criminal cases (Report the disposition of sexual assault, domestic violence/dating violence and/or stalking cases resolved during the current reporting period.)

Type of case	Number dismissed	Number of deferred adjudications	Number convicted	Number acquitted
Sexual assault
Domestic violence/dating violence
Stalking
Violation of protection order
Violations of bail
Violation of probation
Violation of other court order
TOTAL number of dispositions

57. Judicial monitoring (Report the number of sexual assault, domestic violence/dating violence and stalking offenders whose cases were reviewed by the court for compliance with conditions of probation or other court-ordered conditions, or for violations of those conditions. Also report the total number of review hearings conducted. The number of review hearings is the number of individual hearing held for each offender, even when that offender is reviewed during the same monitoring sessions as other offenders. For example, if 10 offenders were reviewed at the same three sessions during the reporting period, the number of offenders reviewed would be 10 and the number of review hearings conducted would be 10 multiplied by 3, or 30.)

	Number of offenders reviewed	Number of review hearings conducted
TOTAL

58. Dispositions of violations (Report the number of sexual assault, domestic violence/dating violence and stalking cases in which there were dispositions of violations during the current reporting period. The violation does not have to have occurred during this reporting period, only the disposition. A case may be counted more than once if there were multiple violations.)

Violation	No action taken	Verbal/ written warning	Fine	Conditions added	Partial revocation of probation	Probation revoked/ incarcerated
Protection order
New criminal behavior
Failure to attend mandated batterers intervention program (BIP)
Failure to attend mandated offender treatment (does not include BIP)
Other condition of probation
TOTAL

59. Victims referred to victim services (Report the total number of victims who were referred to victim services by Tribal Governments Program-funded staff during the current reporting period. Victim services refer to services provided by agencies that serve victims of sexual assault, domestic violence/dating violence, and/or stalking.)

	Tribal victim services	Non-tribal victim services
Number of victims

60. Civil protection orders (Report the total number of temporary and/or final civil protection orders requested and granted for domestic violence/dating violence, sexual assault, or stalking, by the court during the current reporting period. These orders may be referred to as protection from abuse or protection from harassment or anti-harassment, or restraining orders. Include only civil orders.)

Domestic violence/dating violence	Temporary protection orders	Final protection orders
Number of protection orders requested
Number of protection orders granted

61. Criminal protection orders (Report the total number of criminal protection orders requested and the total number granted by the court to victims/survivors of domestic violence/dating violence, sexual assault, or stalking during the current reporting period. These orders may be referred to as no-contact or stay-away orders.)

	Requested	Granted
Number of protection orders

62. (Optional) Additional information (Use the space below to discuss the effectiveness of court activities funded or supported by your Tribal Governments Program grant and to provide further explanation on how these activities increase the safety of American Indian/Alaska Native women.)

E4. Tribal Probation/Offender Monitoring

Were your Tribal Governments Program funds used for probation during the current reporting period? Check yes if Tribal Governments Program funds directly supported probation activities.

• Yes--answer questions 63-67. Provide the information only for Tribal Governments Program-funded probation/offender monitoring activities engaged in during the current reporting period.

• No--skip to Section E5.

63. Number of cases (Report the total number of continuing and new cases involving offenders charged with sexual assault, domestic violence/dating violence, and/or stalking. This is an unduplicated count. If you have not previously filed a semi-annual report, include all pending cases at the beginning of the current reporting period as “number of continuing cases.”)

Misdemeanor and felony domestic violence/dating violence offenses include any assaults, battery, vandalism, or other offenses that occurred in a domestic violence/dating violence incident. Your tribal law does not have to name the offense "domestic violence/dating violence" for it to be counted here. Similarly, sexual assault and stalking offenses should be counted, even if your tribal law uses another name for these types of offenses, such as "sexual battery" or "harassment."

	Number of continuing cases	Number of new cases	Number who completed probation
			Without violations	With violations
Total unduplicated count of sexual assault cases (offenders)
Total unduplicated count of domestic violence/dating violence cases (offenders)
Total unduplicated count of stalking cases (offenders)
Total unduplicated count of cases (offenders)

64. Monitoring activities (For new and continuing cases reported in question 63, report the number of the monitoring activities engaged in during the current reporting period. Report only those offenders who were monitored using the specific activity under “number of offenders.” Report the total number of contacts for all offenders for the specific activity under “total contacts.” For example, out of a total caseload of 50, a probation officer/offender monitor has face-to-face contact 5 times each with 20 of those offenders during the reporting period. Multiplying those offenders by the number of face-to-face meetings an officer/monitor had with each offender, the total contacts amounts to 100. The number of offenders reported as having face-to-face meetings would be 20, and the number of total face-to-face contacts would be 100.)

Activity	Number of offenders	Total contacts
Face-to-face meeting with offender
Telephone contact with offender
Unscheduled surveillance of offender

Activity	Number of victims/survivors	Total contacts
Outreach to victims/survivors

65. Disposition of probation violations (Report the total number of sexual assault, domestic violence/dating violence, and/or stalking cases in which there were dispositions of violations during the current reporting period. The violation does not have to have occurred during this reporting period, only the disposition. A case may be counted more than once if there were multiple violations.)

Violation	No action taken	Verbal/ written warning	Fine	Conditions added	Partial revocation	Probation revoked/ incarcerated
Protection order
New criminal behavior
Failure to attend mandated batterer intervention program (BIP)
Failure to attended mandated offender treatment (does not include BIP)
Other condition of probation
TOTAL

66. Victims referred to victim services (Report the total number of victims who were referred to victim services by Tribal Governments Program-funded staff during the current reporting period. Victim services refer to services provided by agencies that serve victims of sexual assault, domestic violence, dating violence, and/or stalking.)

	Tribal victim services	Non-tribal victim services
Number of victims

67. (Optional) Additional information (Use the space below to discuss the effectiveness of probation activities funded or supported by your Tribal Governments Program grant and to provide further explanation on how these activities increase the safety of American Indian/Alaska Native women.)

E5. Batterer Intervention Program (BIP)

Were your Tribal Governments Program funds used for BIP activities during the current reporting period? Check yes if Tribal Governments Program-funded staff or Tribal Governments Program directly supported funded BIP activities.

• Yes--answer questions 68-71. Provide the information only for Tribal Governments Program-funded BIP activities.

• No--skip to Section F

68. Offenders in program (Report the number of continuing and new offenders in your BIP during the current reporting period. If you have not previously filed an annual report, include all cases at the beginning of the current reporting period as “offenders continuing in BIP.”)

	Number of offenders continuing in BIP from last reporting period	Number of offenders entering BIP during current reporting period
Offenders in program

69. Outcomes (Report the total number of domestic violence/dating violence offenders in your program who successfully completed the program, who were terminated from the program, and who returned to the program after termination during the current reporting period.)

	Number of Offenders
Completed program
Terminated from program
Returned to program after termination
Other: __________

70. Length of BIP in weeks (Report the number of weeks batterers are expected to remain in the program in order to complete it. If your BIP has more than one program length and/or curriculum, provide the length for each type of program.)

	A	B	C
Number of weeks

71. (Optional) Additional information (Use the space below to discuss the effectiveness of BIP activities funded or supported by your Tribal Governments Program grant and to provide further explanation on how these activities increase the safety of American Indian/Alaska Native women.)

F . NARRATIVE

All grantees must answer question 72.

Please limit your response to four pages for this question.

72. Report on the status of your Tribal Governments Program grant goals and objectives as of the end of the current reporting period. (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 73 and 74 on an annual basis.

Please limit your response to two pages for each question.

73. 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 geographic regions, service delivery systems, types of victimizations, jurisdictional issues, and challenges and barriers unique to your service area.)

74. What has the Tribal Governments Program funding allowed you to do that you could not do prior to receiving this funding? (For example, expand services to victims/survivors, increase coordination between tribal and local law enforcement, etc.)

Questions 75, 76 and 77 are optional.

Please limit your response to two pages for each question.

75. Non-tribal criminal justice dispositions. (If you have information about the dispositions of sexual assault, domestic violence/dating violence, and/or stalking offenses that occurred in Indian country and were referred to local, state, or federal law enforcement or prosecutors, please report that information here. If available, include information on whether the offenders and victims were tribal members.

76. Provide additional information regarding the effectiveness of your grant-funded program. (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 Tribal Governments Program grant, please provide it below. Refer to separate instructions for a fuller explanation and examples.)

77. Provide any additional information that may provide explanation 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 funded staff—e.g.,

victim advocates, law enforcement officers, etc.-- but did not report any corresponding victim services or law

enforcement activities, you may explain why; or if you did not use program funds to support either staff or

activities during the reporting period, please explain how program funds were used, if you have not already

done so. .

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.

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TRIBAL GOVERNMENT PROGRAM DRAFT 03/25/08