Form Agency_Instruments

Attachment 15 – Agency Staff Instruments
Document F.1: Existing Data Inventory

NATIVE ASPIRATIONS PROGRAM ACTIVITY TRACKER
You can use this worksheet to track the activities you've conducted in your community to support the Native Aspirations program. List any activity aimed at reducing violence, bullying, and suicide.
Description

Type of Activity

Intended Audience Date

(choose from list below)

(choose from list below)

Community gathering
Training (school-based)
Training (community-based)
Assessment & Referral training for mental health workers
Develop curricula for youth lifeskills training
Cultural activity to build lifeskills, identity, and community connectedness
Early identification screening program
Developing, maintaining, or supporting a crisis hotline
Provide mental health related services
Provide case management services
Provide crisis response services
Provide traditional healing practices
Newsletter
Convene a leadership committee
Develop training materials
Conduct a survey

Example 1
Example 2
Example 3

Activity 1

Activity 2

Activity 3

The Gathering of Native Americans brought together members of the community to begin a
conversation about how violence, bullying, and suicide has affected our youth.
The QPR training was conducted by the Native Aspirations team to train teachers and other members of
the community on how to identify youth at risk for suicide and what to do when youth show signs of
being at risk.
Organized a day camp for youth focused on traditional cultural activities (canoeing, tribal dance,
storytelling, etc.)

Number of
attendees

All ages
Adults
Youth

Community gathering

All ages

8/15/2007

50

Training (school-based)

Adults

10/12/2008

25

Cultural activity to build lifeskills, identity, and community
connectedness

Youth

7/15/2009

50

Description

Activity 4

Activity 5

Activity 6

Activity 7

Activity 8

Activity 9

Activity 10

Activity 11

Activity 12

Type of Activity

Intended Audience Date

Number of
attendees