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U.S. Department of Justice
Office on Violence Against Women 
Semi-Annual Progress Report for
Grants to Support Tribal Domestic Violence and Sexual Assault Coalitions 

Brief Instructions:  This form must be completed for each Grant to Support Tribal Domestic Violence and Sexual Assault Coalition (Tribal Coalitions) grant received.  The grant administrator or coordinator must ensure that the form is completed fully with regard to all grant activities.  Throughout this form, Tribal Coalitions funds include the mandated 25% non-federal grant match. Is this still required?  


All grantees should read through 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, D and subsection A1 of this form must be completed by all grantees.  In subsection A2 and section C, grantees must answer an initial question in each subsection about whether they engaged in certain activities during the current reporting period.  If the response is yes, then the grantee must complete that subsection.  If the response is no, the rest of that subsection is skipped.

For example, 1) if staff funded under this grantyou  only provided training and technical assistance with staff funded under this grant during the current reporting period, you would complete sections and sub-sections A, A1, A2, B, C1, C6, and D (and answer ‘no’ in C2-C5 and C7-C9); or, 2) if staff funded under this grant you provided training and technical assistance with staff funded under this grant and grant-funded staff developed products during the current reporting period, you would complete sections A, B, C1, C4, C56, C6, and D (and answer ‘no’ in C2, C3, C5, and C7.-C9).

The activities of volunteers or interns mayshould be reported if they arewere coordinated or supervised by Tribal Coalitions grantProgram-funded staff or if Tribal Coalitions Program funds substantially support their activities.  

For further information on filling out this form, refer to the separate set of instructions, which contains detailed definitions and examples, illustrating how questions should be answered.

SECTION		  Page Number

Section A: 	General Information                                                                            1		1
                       A1 Grant Information		1
                       A2 Staff Information                                                                            		33
Section B: 	Purpose Areasrogram Activities		4
Section C: 	Function Areas		565
	C1 Training                                                                                         		56
                       C2 Education	         	810	5
	C3 2 System Advocacy		1281023
	C34 Policies                                                                                     		1511357
	C45 Products		14720172
	C5 Education		13
	C6 Topics of Technical Assistance		18515821
	C7 Standards of Service		17
	C8 Other Underserved Populations		18
	C79 Organizational Development and Capacity Building		182042019
Section D:  Narrative		19215201
Appendix A:  Status of Goals and Objectives Table		21

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[s] assigned to your Tribal Coalitions Program grant)
			
			
5.   Type of grantee organization (Check one)
    • EstablishedSexual assault tribal coalition
    • IndividualDomestic violence coalition
    • Other non-profitDual sexual assault/domestic violence coalition 
    • 

6.   Type of coalition
Tribal government 
    • Sexual assault coalition
    • Domestic violence /dating violence coalition
    • Dual sexual assault and /domestic violence/dating violence coalition

67.   Point of contact (person responsible for the day-to-day coordination or administration of the grant)
	
	First Nname 	MI	Last name	 
Agency/organization name (If different from grantee name)	 
Address 	
City_________________________State___________________Zip Code_____________________
Telephone	Facsimile 	
E-mail 		

78.   What percentage of your tribal coalition operating budget is funded by this Tribal Coalitions Program
grant?  	

89. 	What tribal population(s) is(are) served by your Tribal Coalitions Program grant?
	
	
	

910.  Did this tribal coalition exist prior to receiving Tribal Coalitions Program grant funds?  
	
    • Yes
    • No 

110.  Coalition members (Report the total number of organizational members, including sexual assault programs, domestic violence /dating violence programs, other victim services agencies, and other organizational members., as applicable to your tribal coalition.  Report the total number of individual members, if applicable, to of your tribal coalitions, if any.  Individual members are individual persons, not programs.)

Coalition members
Number
Sexual assault programs/rape crisis centers

Domestic violence/dating violence programs

Dual sexual assault and domestic violence/dating violence programs

Tribal victim services agencies

Other victim service providers

Other organizational members

Total number of organizational members


Total number of individual members



A2.  Staff Information
Were Tribal Coalitions Program funds used to fund staff positions during the current reporting period?  Check yes if Tribal Coalitions Program funds were used to pay staff, including part-time staff and contractors.
    • Yes--answer question 121
    • No--skip to Section B

121. Staff (Report the total number of full-time equivalent [FTE] staff funded by your Tribal Coalitions Program grant during the current reporting period.  Report staff by the 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.  If an employee or contractor was not employed or utilized for only a portion of over the entire reporting period, prorate appropriately report the average.  For example, if you hired a full-time administrator in October who was 100% funded with Tribal Coalition Program funds, you would report that as .5 FTEs.  Report all FTEs in ound to the second 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 FTEs for part-time staff and contractors.)  
            
Staff
FTE(s)Grant-funded staff
Administrator (executive director, fiscal manager)

Civil aAttorney

Communication specialist (public awareness, media relations)

Information technology staffpecialists

Native women/tribal cultural specialist

Paralegal

Program coordinator (training coordinator, outreach coordinator)

Support staff (secretary, administrative assistant, accountant, bookkeeper)

System advocate

Technical assistance provider

Trainer/educator

Tribal cultural specialist

Other(specify):_________________________________

Total 


  

B.  PURPOSE AREASROGRAM ACTIVITIES

All grantees must complete this section.

132. Purpose Areasrogram Activities (Check all program activitiesurpose areas that apply to activities supported with Tribal Coalitions Program funds during the current reporting period.) 
 
Check ALL that apply
Purpose Areasrogram activities
    • 
Increasing awareness of domestic violence/dating violence and sexual assault against American Indian and Alaska Native womenBringing local tribal programs together to identify gaps in services and to coordinate activities
    • 
Enhancing the response to violence against American Indian and Alaska Native women at the tribal, Federal, and State levels Conducting statewide, regional and/or tribally-based meetings or workshops for tribal victim advocates, survivors, community members, legal services staff, health care professionals, and criminal justice representatives
    • 
Identifying and providing technical assistance to coalition membership and tribal communities to enhance access to essential services to American Indian women victimized by domesticc/dating and sexual violenceCoordinating and presenting public awareness or community education programs (including education for youth) to increase understanding of domestic violence and sexual assault
    • 
Developing or enhancing appropriate standard of services for service providers
    • 
Engaging in systems advocacy to effect policy and/or procedural change in order to improve institutional responses to domestic violence and sexual assault
    • 
Establishing and maintaining an office and hiring staff (reasonable costs in connection with the establishment of an organization are allowable)
    • 
Expanding the capacity of coalitions 
    • 
Providing technical assistance to coalition members, programs, organizations, and service providers
    • 
Providing limited direct services and advocacy to victims of domestic violence and sexual assault including crisis hotlines, assistance with shelter and transitional housing, court accompaniment, referrals, support groups, and civil legal services

123a. Program priority areas addressed by your grant (In addition to the purpose areas identified above, the Tribal   
       Coalitions Grant Program Application and Program Guidelines may have identified several program priorities that would  
        receive priority consideration.  If your project addressed any of these priority areas during the current reporting period,  
       list them below.)










 
14.  OtherCulturally-specific activities (List all other activities, not included in question 12, culturally-specific activities that which your tribal coalitions engaged in during the current   
       reporting period in the community(ies) you serve.  Check the box in the first column if the activity was funded with Tribal  
       Coalitions Program funds.)

Tribal Coalitions funded 
Activity
    • 
a.
    • 
b.
    • 
c.
    • 
d.
    • 
e.
    • 
f.


15.  (Optional)  Additional iInformation (Use the space below to discuss the effectiveness of your culturally-specific activities funded or supported by your Tribal Coalitions Program grant and to provide further explanation on how these activities increase the safety of American Indian/Alaska Native women.)

C.  FUNCTION AREAS

C1. Training
Were your Tribal Coalitions Program funds used for training during the current reporting period?  Check yes if Tribal Coalitions Program-funded staff provided training or if Tribal Coalitions Program funds were used to directly support the training.   
    • Yes--answer questions 164-196
    • No--skip to C2

For the purposes of this reporting form, training means providing information on sexual assault, dating violence, , domestic violence, and stalking that enables a personrofessionals 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 C2.5 

164.  Type and number of training events provided (Report the number of statewide, regional, and tribal-based training events by the type of training that were either provided by Tribal Coalitions Program-funded staff or directly supported with Tribal Coalitions Program funds.  Staff development training provided to Tribal Coalitions Program--funded staff should not be counted.  Use the Sexual assault/Domestic violence /dating violence  columns if training events focused on both sexual assault and domestic violence.)

Type of training
Total number of training events

Statewide
Intra-state regions
Tribal

Sexual assault
Domestic violence
Sexual assault//
Domestic violence
Sexual assault
Domestic violence
Sexual assault/
Domestic violence
Sexual assault
Domestic violence
Sexual assault //
Domestic violence
Computer-based training









Conferences









Teleconferences









Videoconferences









Workshops/
seminars 









Other (specify): __________












175. 	Number of people trained (Report the number of people trained during the current reporting period by Tribal Coalitions Program-funded staff or training supported by Tribal Coalitions Program funds.  Use the category that is most descriptive of the people attending the training event.  Tribal Coalitions Program-funded staff attending staff development training should not be counted. If you do not know how many people to report in specific categories, you may report the overall number in “Multidisciplinary.”.))

People trained
Number
Attorneys/law students (does not include prosecutors)

Batterer intervention program/offender accountability staff

Child protective service workers 

Children’s advocates (not affiliated with CPS)

Community advocacy organization staff (National Indian Council on Aging, National Congress of American Indians)

Correction personnel (probation, parole, and correctional facility staffies)

Court personnel (tribal—judges, clerks)

Court personnel (non-tribal—judges, clerks)

Domestic violence/dating violence program staff (tribal)

Domestic violence/dating violence program staff (non-tribal)

Educators (teachers, administrators, etc.)

Faith-based organization staff

Federal agency staff (BIA, IHHIS, FBI) 

Health professionals (doctors, nurses; does not includeexcluding forensic examiners)

Law enforcement officers (tribal)

Law enforcement officers (non-tribal)

Legal services staff (does not include attorneys)

Mental health professionals 

Military command staff

Multidisciplinary group (various disciplines at same training)

Other government agency staff (vocational rehabilitation, food stamps, TANF)

Prosecutors (tribal)

Prosecutors (non-tribal)

Sexual assault forensic examiners/sexual assault nurse examiners (SAFE/SANE)AFE/SANEexual assault forensic examiners

Sexual assault program staff (tribal)

Sexual assault program staff (non-tribal)

Social service organization staff (non-government—food bank, homeless shelter, etc.)

Tribal community groups 

Tribal elders 

Tribal government

Tribal government/Tribal government agency staff

Victim assistants (governmental, includes victim-witness specialist/coordinator)-witness specialists

Volunteers

Other (specify):

Total








168.  Training content areas (Indicate all topics covered in training events provided bywith your Tribal Coalitions Program funds-funded staff or directly supported with Tribal Coalitions 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 custody in the context of violence against women
    • Child witnesses in the context of domestic violence/dating violence
    • Confidentiality 
    • Cultural issues specific to American Indians and/or Alaska Natives
    • Dating violence overview, dynamics, and services
    • Domestic violence/dating violence overview, dynamics, and services 
    • Drug facilitated sexual assault 
    • Dynamics and history of violence against American Indian and/or Alaska Native women 
    • Historical trauma
    • Indian Child Welfare Act 
    • Safety planning for victims/survivors 
    • Sexual assault overview, dynamics,  and services
    •  
    • Stalking overview, dynamics, and services
    • Supervised visitation and exchange 
    • Tribal strategies to address sexual assault or domestic violence 
    • Other (specify):				

Organizational community response
    • Coalition development 
    • Collaboration
    • Coordinated community response 
    • Discrimination and oppression issues
    • Evaluation
    • Federal agency response to sexual assault and domestic violence/dating violence (IHS, BIA, FBI, USAO)
    • Outreach
    • Program accessibility
    • Program rules
    • Public benefits (TANF, disability, food stamps, unemployment, etc.)
    • Response teams (DART, DVRT, SART)
    • Strategic planning
    • Technology
    • Tribal strategies to address sexual assault or domestic violence//dating violence, or stalking 
    • Victim service administration and operations 
    • Other (specify):				

Other underserved populations 
Issues specific to American Indian and Alaska Native victims/survivors who
    • are elderly 
    • are disabled
    • are homeless or living in poverty
    • are isolated or institutionalized
    • are lesbian, gay, bisexual, transgender, or intersex
    • have disabilities
    • have mental health issuesproblems 
    • have substance abuse issues
    • live in rural areas
    • live in urban areasproblems 
    • Other (specify):_______________________				
Justice system
    • Court procedures 
    • Decreasing dual arrests/identifying predominant aggressor 
    • 

    • Domestic violence/dating violence statues/codes development 
    • Evidence analysis, collection, and preservation
    • Evidence-based prosecution
    • Firearms and domestic violence/dating violence 
    • Immigration statutes
    • Judicial response 
    • Law enforcement response (including protocols, arrest policies, and evidence collection)
    • Mandatory reporting requirements 
    • Pro-arrest policies
    • Prosecution response 
    • Protection orders (including full faith and credit)
    • Sex offender registry(ies)
    • Sexual assault forensic examinations
    • Sexual assault statutes/codes development
    • Stalking statutes/codes development
    • Tribal jurisdiction and Public Law 280 
    • Other (specify)::				











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



C2.  Education
Were your Tribal Coalitions Program funds used for education activities during the current reporting period?  Check yes if Tribal Coalitions Program-funded staff engaged in were used to support education activities or if Tribal Coalitions Program funds were used to funds were used to directly support education activities. 
    • Yes--answer questions 1720-1923
    • No--skip to C3

For the 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 a professional to improve her/his response to victims/survivors of sexual assault, domestic violence/, dating violence, and stalking.  In this subsection, report information on education activities.only. Training should be reported in subsection C1.  

2017.  Education events (Report the total number of education events provided during the current reporting period. that were either provided by Tribal Coalitions-funded staff or directly supported by Tribal Coalitions funds.)

Total number of education events provided _________

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


18. People educated with Tribal Coalitions funds (Report the number of people attending education events during the current reporting period.:TotalTOTAL


People attending event
Number


Tribal
Non-
tribal

Child care providers



Community businesses (retail stores, pharmacies)



Community groups (service or social groups)



Community members 



Employers



Faith-based groups



Men’s groups



Parents/guardians



Students 



Tribal elders



Tribal government/tribal government agency staff



Victims/survivors (do not count psycho-educational support groups)



Women’s groups



Other (specify)



Total





2219. Topics of education events provided with Tribal Coalitions Program funds (Indicate all topics covered in education provided with your Tribal Coalitions Program funds during the current reporting period.  Check all that apply.). 

Sexual assault, domestic violence, /dating violence and stalking
    • Dating violence overview, dynamics and services
    • Domestic violence/dating violence overview, dynamics and services
    • Historical trauma
    • Indigenous awareness programs 
    • Mandated reporting of child victimization
    • Safety planning 
    • Sex offender registry(ies)
    • Sexual assault overview, dynamics, and services 
    • Stalking overview, dynamics, and services 
    • VAWA 
    • 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 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): 					





23.  (Optional)  Additional iInformation (Use the space below to discuss the effectiveness of your education activities funded or supported by your Tribal Coalitions Program grant and to provide further explanation on how these activities increase the safety of American Indian/Alaska Native women.)
C32.  System Advocacy
Were your Tribal Coalitions Program funds used for system advocacy during the current reporting period? Check yes if Tribal Coalitions Program-funded staff engaged in system advocacy or if Tribal Coalitions Program funds were used to directly support system advocacy.  (System advocacy is an activity intended to effect policy and/or procedural change in order to improve institutional response to sexual assault and/or domestic violence/dating violence.)  
    • Yes--answer questions 240-272217-19
    • No--skip to C43

24017.  System advocacy activities (Indicate the system advocacy activities convened or participated in with Tribal Coalitions Program funds during the current reporting period.  Check all that apply.)

Systems advocacy
Sexual assault
Domestic violence/dating violence
Appointed tribal and state commissions
    • 
    • 
Community, regional, statewide task force/caucus
    • 
    • 
Multidisciplinary working groups
    • 
    • 
Project-specific interagency working groups
    • 
    • 
Tribal systems advocacy
    • 
    • 
Other (specify): _________________________
    • 
    • 



























25118. Improved system response (Report the total number of statewide, regional, and local meetings convened and/or attended by Tribal Coalitions Program--funded staff during the current reporting period.  Report based on the primary group in attendance.  If there were multiple agencies or organizations at the meeting, count the meeting as a multidisciplinary meeting.  Each meeting should be counted only once.)

Agency/organization/people
Number of meetings convened
Number of meetings attended

Sexual assault
Domestic violence/dating violence
Sexual assault
Domestic violence/dating violence
American Indian or Alaska Native women




Batterer intervention program/offender accountability staff 




Child advocacy organization (not affiliated with CPS)




Child welfare agency




Community advocacy organizations (National Indian Council on Aging, National Congress of American Indians)




Corrections (probation, parole, correctional facility) 




Court (tribal)




Court (non-tribal)




Crime victim compensation




Domestic violence/dating violence program (tribal)




Domestic violence/dating violence program (non-tribal)




Dual sexual assault and domestic violence/dating violence program (tribal)




Dual sexual assault and domestic violence/dating violence program (non-tribal)




Educational institution/Uuniversity/Sschool 




Faith-based organization 




Federal government  agency staffies (IHS, BIA, FBI)




Government agency agency staff (INS, Social Security, TANFSstate and Llocal)




Health/mental health organization




Law enforcement agency (tribal)




Law enforcement agency (non-tribal)




Legal services organization (legal services, bar association, law school) 




Multi-disciplinary group/task force




People representing other underserved populations




Prosecutor’s office (tribal)




Prosecutor’s  office (non-tribal)




Sexual  Aassault Nnurse Eexaminer/sSexual Aassault Fforensic Eexaminer program (SANE/SAFE)FE/SANE programexual assault forensic examiner program




Sexual assault program (tribal)




Sexual assault program (non-tribal)




Social services organization (food bank, homeless shelter)




Substance abuse services




Tribal community groups




Tribal elders




Tribal government/Tribal government agency




Victims/survivors




Victim assistant (governmental, includes victim-witness specialist/coordinator)-witness specialists




Other (specify):




Total






26219. Coordination activities (Indicate other methods used during the current reporting period to coordinate tribal victim services activities and/or to collaborate and coordinate with federal, state, and local entities engaged in activities to reduce or end violence against women.  Check all that apply.)

    • E-mail
    • E-mail listserv
    • Fax
    • Newsletter
    • Telephone/conference call listserv
    • Toll-free telephone number
    • Tracking availability of victim services
    • U.S. Mail
    • Web site
    • Other (specify): 				


27.  (Optional)  Additional iInformation (Use the space below to discuss the effectiveness of your system advocacy activities funded or supported by your Tribal Coalitions Program grant and to provide further explanation on how these activities increase the safety of American Indian/Alaska Native women.)
C43.  Policies   
Were your Tribal Coalitions Program funds used to develop or, substantially revise, or implement policies or protocols during the current reporting period?  Check yes if Tribal Coalitions Program-funded staff developed or, substantially revised, or implemented policies or protocols or if Tribal Coalitions Program funds were used to directly support the development or, substantial revision, or implementation of policies or protocols.  
    • Yes--answer questions 28-2930
    • No--skip to C54

2830.  Types of policies and/or protocols developed or, substantially revised, or implemented during the current reporting period. (Check all the policies or protocols developed ord, substantially revised, or implemented with Tribal Coalitions Program funds during the current reporting period.  Use the SA column for policies and/or protocols addressing sexual assault and the DV column for those addressing domestic violence/dating violence.)
 
Victim services 
SA
DV

    • 
    • 
Appropriate response to underserved populations
    • 
    • 
Confidentiality
    • 
    • 
Procedures for anonymous, confidential, or Jane Doe reporting of sexual assault
    • 
    • 
Training standards for staff and volunteers
    • 
    • 
Staff, board, and/or volunteers represent the diversity of your service area 
    • 
    • 
Standards of service
    • 
    • 
Victim/survivor informed about Crime Victims Compensation and Victim Impact Statements
    • 
    • 
Other (specify) : ______________________

Law enforcement 
SA
DV

    • 
    • 
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/or stalking
    • 
    • 
No charge to sexual assault victims/survivors for any cost associated with forensic exam
    • 
    • 
No victims/survivors polygraphed
    • 
    • 
Pro-arrest/mandatory arrest
    • 
    • 
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
    • 
    • 
Sexual assault response and protocolsProviding information to victims/survivors about victim services
    • 
    • 
Stalking response and protocols
    • 
    • 
Other (specify): ______________________

Prosecution 
SA
DV

    • 
    • 
Appropriate response to underserved populations 
    • 
    • 
Mandatory training on sexual assault, domestic violence/dating violence, and/or stalking
    • 
    • 
No charge to victims/survivors for any costs related to the prosecution of sexual assault, domestic violence/dating violence and/or stalking
    • 
    • 
No victims/survivors polygraphed
    • 
    • 
Protection order enforcement (including full faith and credit)
    • 
    • 
Sexual assault response and protocols
    • 
    • 
Stalking response and protocols
    • 
    • 
Vertical prosecution
    • 
    • 
Victim witness notification
    • 
    • 
Other (specify): _____________________

Court
SA
DV

    • 
    • 
Accelerated trial schedules
    • 
    • 
Appropriate response to underserved populations
    • 
    • 
Dedicated sexual assault or domestic violence/dating violence docket
    • 
    • 
Full faith and credit for protection orders
    • 
    • 
Immediate access to obtain 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 sexual assault victim/survivor for any cost associated with forensic exam
    • 
    • 
Policy against mutual restraining orders
    • 
    • 
Procedures for courtroom security
    • 
    • 
Other (specify): _______________________

Probationon and parole policies
SA
DV

    • 
    • 
Mandatory training on sexual assault, domestic violence/dating violence, and/or stalking
    • 
    • 
Strategies to assist and protect victims/survivors during probationon and parole
    • 
    • 
Perform checks on police logs, criminal and civil databases
    • 
    • 
Special procedures for cases involving diverse, underserved populations
    • 
    • 
Offender monitoring
    • 
    • 
Other (specify): ________________

Health care 
SA
DV

    • 
    • 
Advocate response in emergency room
    • 
    • 
Appropriate response to underserved populations
    • 
    • 
Forensic evidence collection and documentation
    • 
    • 
Forensic exams not billed to victims/survivors
    • 
    • 
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): ____________________



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


























































C54.  Products 
Were your Tribal Coalitions Program funds used to develop, substantially revise, or distribute products during the current reporting period?  Check yes if Tribal Coalitions Program-funded staff developed products or if Tribal Coalitions Program funds were used to directly supported the development, revision, or distribution of products.  
    • Yes--answer question 30241
    • No--skip to section C65

2430. Use of Tribal Coalitions Program funds for product development, substantial revision, or distribution (Report the number of products developed, substantially revised, or distributed with Tribal Coalitions 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; the 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 substantially revised during the current reporting period whether or not they were used or distributed, and on products 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

















Newsletter

















Training curricula

















Training materials

















Reports





























Web site (report number of page views in the used or distributed column)





















Videos

















Tribal Codes

















Other (specify):



















C5.  Education
Were your Tribal Coalitions funds used for education activities during the current reporting period?  Check yes if Tribal Coalitions-funded staff were used to support education activities or if Tribal Coalitions funds were used to directly support education activities. 
    • Yes--answer questions 22-25
    • No--skip to C6

For the purposes of this reporting form, education means providing general information that will increase awareness of sexual assault, domestic violence, and stalking.  Training means providing information on sexual assault, domestic violence, and stalking that enables a person to improve her/his response to victims/survivors of sexual assault, domestic violence, and stalking.  In this subsection, report information on education only.  

22.  Education events (Report the total number of education events provided during the current reporting period that were either provided by Tribal Coalitions-funded staff or directly supported by Tribal Coalitions funds.)

Total number of education events provided _________

23. People educated with Tribal Coalitions funds (Report the number of people attending education events during the current reporting period.)

People attending event
Number


Tribal
Non-
tribal
Child care providers


Community advocacy organizations (National Indian Council on Aging, National Congress of American Indians)


Community businesses (retail stores, pharmacies)


Community groups (service or social groups)


Community members 


Employers


Faith-based groups


Men’s groups


Parents/guardians of students


Students 


Tribal elders


Tribal government/tribal government agency staff


Victims/survivors (do not count psychoeducational support groups)


Women’s groups


Other (specify)


Total




24. Topics of education events provided with Tribal Coalitions funds (Indicate all topics covered in education provided with your Tribal Coalition funds during the current reporting period.  Check all that apply). 

Sexual assault, domestic violence and stalking
    • Dating violence overview, dynamics and services
    • Domestic violence overview, dynamics and services
    • Indigenous awareness programs 
    • Mandated reporting of child victimization
    • Safety planning 
    • Self-defense 
    • Sexual assault overview, dynamics, and services 
    • Sexual harassment overview, dynamics, and services
    • Stalking overview, dynamics, and services 
    • Youth awareness of sexual assault, domestic violence, and stalking
    • Workplace violence
    • Other (specify): 	




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


C6.  Technical Assistance
Were your Tribal Coalitions Program funds used to provide technical assistance during the current reporting period?  Check yes if Tribal Coalitions Program-funded staff provided technical assistance or if Tribal Coalitions Program funds were used to directlyly supported the provision of technical assistance.  
    • Yes--answer questions 3125-3326
    • No--skip to C7

31.25  Number of technical assistance activities (Report the total number of technical assistance activities provided to programs during the current reporting period, indicating whether they were site visits or other types of consultations.  Consultations may include in-person, telephonic, electronic, or other types of contact.  Each contact should be counted as one activity.)

Recipients of technical assistance
Number of site visits
Number of other technical assistance consultations
Batterer intervention/offender monitor program 


Child welfare agency (Child Protective Services)


Community advocacy organizations (National Indian Council on Aging, National Congress of American Indians) 


Corrections (probation, parole, correctional facility) 


Court (tribal)


Court (non-tribal)


Disability organization


Domestic violence/dating violence program (tribal)


Domestic violence/dating violence program (non-tribal)


Dual sexual assault and domestic violence/dating violence program 


Elder organization


Faith-based organization 


Federal agencies (BIA,CIA,FBI,IHS)


Health/mental health organization


Law enforcement (tribal)


Law enforcement agency (non-tribal)


Legal services organization (legal services, bar association, law school) 


Military command staff


Other tribal coalition


Prosecutor’s office (tribal)


Prosecutor’s office (non-tribal)


Sexual assault forensic examiners/sexual assault nurse examiners (SAFE/SANE)


Sexual assault program (tribal)


Sexual assault program (non-tribal)


Tribal community groups


Tribal government/Tribal government agency


University/school


Youth program


Other (specify):


Total




3226.  Topics of technical assistance (Check the topics that apply to technical assistance provided with Tribal Coalitions Program funds during the current reporting period.  The technical assistance provided may be categorized by more than one topic.  Check all that apply.)

Topics of technical assistance
Sexual assault
Domestic violence/dating violence
Coordinated community response
    • 
    • 
Court response
    • 
    • 
Criminal codes
    • 
    • 
Curricula and training issues
    • 
    • 
Developing or enhancing culturally appropriate services for underserved  populations 
    • 
    • 
Developing or enhancing appropriate services for elder victims/survivors
    • 
    • 
Developing or enhancing appropriate services for victims/survivors who have disabililtiesdisabilities
    • 
    • 
Forensic evidence collection and documentation
    • 
    • 
Law enforcement response
    • 
    • 
Probation response
    • 
    • 
Program development
    • 
    • 
Program evaluation
    • 
    • 
Prosecution response
    • 
    • 
Response to dating violence victims/survivors
    • 
    • 
Response to domestic violence/dating violence victims/survivors
    • 
    • 
Response to sexual assault victims/survivors
    • 
    • 
Response to stalking victims/survivors
    • 
    • 
Safety planning
    • 
    • 
Sex offender registry(ies)
    • 
    • 
Standards of service
    • 
    • 
Technology and technology capacity (data collection systems and confidentiality) 
    • 
    • 
Technology safety and security
    • 
    • 
Tribal codes
    • 
    • 
University/school
    • 
    • 
Victim service administration and operations
Other (specify): _____________________________________
    • 
    • 
Other (specify):
    • 
    • 

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

C7.  Standards of Service
Were your Tribal Coalitions funds used to develop or enhance standards of service for law enforcement, prosecution, courts, probation or victim services programs/agencies during the current reporting period?  Check yes if Tribal Coalitions-funded staff were used to develop or enhance standards of service or if Tribal Coalitions funds were used to directly support the development or enhancement of standards of service.  
    • Yes--answer question 27
    • No--skip to C8

27.  Standards of service (Indicate if Tribal Coalitions funds were used to develop, implement, or enhance standards of service or provide training on standards of service for law enforcement, prosecution, courts, probation, or victim services programs/agencies.  Check all that apply.) 
 

Sexual assault
Domestic violence
Developing standards of service for law enforcement, prosecution, courts, probation, and/or victim services
    • 
    • 
Implementing standards of service for law enforcement, prosecution, courts, probation, and/or victim services
    • 
    • 
Enhancing standards of service for law enforcement, prosecution, courts, probation, and/or victim services
    • 
    • 
Training on standards of service for law enforcement, prosecution, courts, probation, and/or victim services 
    • 
    • 





C8.  Other Underserved Populations
Were your Tribal Coalitions funds used to develop or enhance services for underserved populations or to encourage the representation of underserved populations in coordination activities during the current reporting period?  Check yes if Tribal Coalitions-funded staff were used to develop or enhance services for underserved populations or if Tribal Coalitions funds directly supported representation of underserved populations in coordination activities.  
    • Yes--answer question 28-29
    • No--skip to C9

28.  Activities addressing underserved populations (Check all activities that were engaged in with Tribal Coalitions funds to develop or enhance services for underserved populations or to encourage the representation of underserved population in coordination activities.  Check the boxes in the appropriate columns to indicate whether the activities you engaged in were for sexual assault or domestic violence programs/services.)

Activity
Sexual assault
Domestic violence
Developing/distributing materials for underserved populations
    • 
    • 
Developing policy
    • 
    • 
Identifying gaps in services
    • 
    • 
Identifying underserved populations
    • 
    • 
Increasing organizational capacity for anti-oppression work
    • 
    • 
Coordinating a task force/caucus to address issues concerning underserved populations
    • 
    • 
Supporting representatives of underserved groups to participate in meetings
    • 
    • 
Training/technical assistance regarding culturally appropriate services for underserved populations
    • 
    • 
Other (specify):______________________________________________________
    • 
    • 

29. Underserved populations (Indicate which underserved populations were addressed in the activities indicated in question 28.  Check all that apply.)

American Indian and/or Alaska Native victims/survivors who:
    • are elderly 
    • are homeless or living in poverty 
    • are lesbian, gay, bisexual, transgender, or intersex
    • have disabilities 
    • have mental health problems 
    • have substance abuse problems 
    • live in rural areas
    • Other (specify): 				
    • 
    • 
    • 
    • 
    • 
    • 
    • 
    • 
    • 
    • 
    • 
    • C79.  Organizational Development and Capacity Building of Tribal Coalitions
Were your Tribal Coalitions Program grant funds used for organizational development and/or capacity building during the current reporting period? Check yes if Tribal Coalitions Program-funded staff engaged in organizational development and/or capacity building activities, or if Tribal Coalitions Program grant funds were used to directly support organizational development and/or capacity building. 
    • Yes--answer questions 3427-352830-31
    • No--skip to section D

342730. Coalition development and capacity building (Check all activities that were engaged in with Tribal Coalitions Program funds during the current reporting period.)

Activity

Anti-oppression work 
    • 
Board member development
    • 
Communication (TTY, language lines, etc.)
    • 
Develop personnel policies
    • 
Emergency preparedness
    • 
Equipment purchase (computers, printers, faxes, telephones, cell phones, etc.)
    • 
Evaluation/outcome measures, development or tracking
    • 
Identify gaps in service
    • 
Internet/e-mail /listserv development
    • 
Office space (opening/maintaining)
    • 
Outreach to underserved populations
    • 
Software purchase or development
    • 
Staff development
    • 
Strategic planning
    • 
Technology security and safety
    • 
Toll-free telephone line operation
    • 
Web site development or enhancement
    • 
Other (specify):______________________
    • 

352831.  Do you consider system privacy and/or security when purchasing or developing software?
    • Yes
    • No










D. NARRATIVE 

All grantees must answer question 362932
Please limit your response to four pages for this question.

362932.  Report on the status of the goals and objectives for the tribal coalitions (Using Appendix A, rReport 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 3703 and 34 318 on an annual basis.  Please submit this information on the January to June reporting form only. 
Please limit your response to two pages for each question.

3703.  What do you see as the most significant areas of remaining need, with regard to improving services to ncreasing 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 area served, service delivery systems, types of victimization, jurisdictional issues, and challenges and barriers unique to the tribal communities served by your tribal coalitions.) 

3814.  What has the Tribal Coalitions Program funding allowed you to do or maintain that you could not do without receiving this funding?  (For example, has the funding enabled you to identify and eliminate gaps in services; improve services to tribal populations; or, improve criminal justice response to American Indian and/or Alaska Native women?  Provide specific examples in your answer [e.g., opened an office with 2two full- time staff].)

Questions 39 and 4025 areis optional.  
Please limit your response to two pages for each question.

3925.  Provide any additional information that you would like us to know about your Tribal Coalitions grant and/orregarding the effectiveness of your grant-funded program. (If you have other data or information that you have not already reported in answers to previous questions that demonstrate the effectiveness of your regarding your program that would more fully or accurately reflect the effectiveness of your Tribal Coalitions-funded p Program grant, please provide it below.  Refer to separate instructions for a fuller explanation and examples.)than the data requested on this form, answer this question. If you have not already done so elsewhere on this form, feel free to discuss any of the following: systems-level changes, collaborations, the removal or reduction of barriers and challenges for American Indian and/or Alaska Native victims/survivors, and promising practices.)

40.  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 submitted, please answer this question.  For example, if two grant reports were submitted, you may explain how the data was apportioned to each report; if you funded staff but did not report any 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 7th Street, NW, Washington, DC 20531.
 APPENDIX A

Goals/Objectives (describe your goals and objectives, as outlined in your grant proposal, or as revised)
Key Activities
Status (e.g., completed, in progress, delayed, revised)
Comments (Successes, challenges, explanations)