Form 1122-XXXX Semi-annual Progress Report for Children and Youth Expos

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U.S. Department of Justice
Office on Violence Against Women
SEMI-ANNUAL PROGRESS REPORT FOR
Grants to Assist Children and Youth Exposed to Sexual Assault,
Domestic Violence, Dating Violence, and Stalking Program
Brief Instructions: This form must be completed for each Grants to Assist Children and Youth Exposed to Sexual Assault, Domestic Violence, Dating Violence, and Stalking Program (CEV Program)
grant received. A grant administrator or coordinator must ensure that the form is completed fully
with regard to all grant-funded activities. Grant partners, however, may complete sections relevant
to their portion of the grant. Grant administrators and coordinators are responsible for compiling
and submitting a single report that reflects all information collected from grant partners.
Following are some guidelines regarding which sections of the form must be completed by CEV
Program grantees:
• All grantees must complete sections A, B, C2, and E of this form.
• Grantees providing services for children who are victims of or are exposed to violence must
also complete section D.
• In subsections, C1, C3, and C4 grantees must answer an initual question about whether they
engaged in certain activities during tht current reporting period. If the response is yes, then
the grantee must complete that subsection. If the response is no, the rest of the subsection is
skipped.
For example,
1) If you are a victim services agency providing services under this grant, you would complete
the following sections and subsections: A1, A2, B, C2, D, and E.
2) If you are a state maternal and child health agency providing training, coordination, and

advocacy under this grant for programs serving children and youth in your state, you would
complete the following sections and subsections: A1, A2, B, C1, C2, and E.
3)

If you are a tribal nonprofit victim services agency providing services under this grant that is
also using grant funds to provide training, coordination, and advocacy for programs serving
children and youth, you would complete the following sections and subsections: A1, A2, B,
C1, C2, D, and E.

The activities of volunteers or interns should be reported if they were coordinated or supervised by
CEV Program-funded staff or if CEV Program funds substantially supported their activities.
For further information on filling out this form, refer to the separate instructions, which contain
detailed definitions and examples illustrating how questions should be answered.
Section

Section

Section A:
A1:
A2:
Section B:
Section C:
C1:
C2:
C3:
C4:
Section D:
Section E:

General Information
Grant Information
Staff Information
Purpose Areas
Function Areas
Training
Coordinated Community Response
Policies
Products
Victim Services
Narrative

PageNumber
Number
Page

1
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A1

GENERAL INFORMATION
Grant Information

All grantees must complete this subsection.

1.

Date of report

(format date with 6 digits — 07/30/12)

2.

Current reporting period

January 1–June 30

3.

Grantee name

July 1–December 31

(Year)

4. Grant number
ssss(the federal grant number assigned to your CEV Program grant)
5.

Type of grantee organization
(Check the one answer that best describes the type of agency/organization administering your CEV
Program funds.)
After-school program

Health or mental health provider

Childcare program

School

Child advocacy organization

Sexual assault program

Community-based organization

Tribal nonprofit organization

Culturally-specific organization

Tribal government

Domestic violence program

Unit of local government

Dual program (domestic violence and
sexual assault)
Head Start

Unit of state or territorial government
Other (specify):

6.

Is this a faith-based organization?
Yes
No

7.

Point of contact
(person responsible for the day-to-day coordination of the grant)
First name

MI

Last name

Agency/organization name
Address
City
Telephone

State

Zip code

Facsimile

E-mail

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8a.

What underserved populations does this grant specifically address?
(Check all that apply.)

Child victims or children exposed to violence who:
are African
are American Indian or Alaska Native
are Asian
are black or African American
are D/deaf or hard of hearing
are Hispanic or Latino
are homeless/runaway
are immigrants, refugees, or asylum seekers
are lesbian, gay, bisexual, transgender, or intersex
are Middle Eastern
are Native Hawaiian or Other Pacific Islander
are sexually exploited
belong to a particular religion/spiritual group (specify):
have disabilities
have limited English proficiency
have mental health issues
have substance abuse issues
live in rural areas
Other (specify):

8b.

Additional information
Provide additional information about the populations served (for example that the child victims or
children exposed to violence you are serving are: Spanish-speaking from Guatemala, the Dominican
Republic, or Mexico; Orthodox Jews). (Maximum — 2,000 characters)

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8c.

If your services or resources are specifically targeted to reach a particular linguistic or cultural
group, please describe how they are tailored to this group. (Maximum — 2,000 characters)

9.   Does this grant specifically address tribal populations?
(Check yes if your CEV Program grant focuses on tribal populations, and indicate which tribes or
nations you serve or intend to serve.)
Yes
No
If yes, which tribes/nations: (Maximim ­— 75 characters)

10.

What percentage of your CEV Program funds was directed to each of these areas?
(Report the area[s] addressed by your CEV Program grant during the current reporting period and
estimate the approximate percentage of funds [or resources] used to address each area [consider
staff, 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
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. The term dating violence is defined as violence committed by
a person who is or has been in a social relationship of a romantic or intimate nature with the victim.
Stalking is defined as a course of conduct directed at a specific person that 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 (must equal 100%)

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A2

SECTION

Staff Information

Were CEV Program funds used to fund staff positions during the current reporting period?
Check yes if CEV Program funds were used to pay staff, including part-time staff and contractors.
Yes—answer question 11
No—skip to Section B
11. Staff
(Report the total number of full-time equivalent [FTE] staff funded by the CEV 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. For example, if you hired a
full-time advocate in October who was 100% funded with CEV Program funds, you would report that as
.50 FTEs. Report all FTEs in decimals, not percentages. One FTE is equal to 1,040 hours—40 hours per
week multiplied by 26 weeks. See separate instructions for examples of how to calculate and prorate
FTEs.)
Staff

FTE(s)

Administrator (director, fiscal manager)
Case manager
Child advocate
Counselor (advocate, peer, etc., does not require licensure or
certification)
Legal advocate (does not include attorney or paralegal)
Mental health professional (licensed or certified counselor or
therapist, psychologist, or psychiatrist)
Outreach worker
Program coordinator (training coordinator, victim services
coordinator, project coordinator, volunteer coordinator)
Support staff (bookkeeper, accountant, administrative
assistant)
Trainer
Translator/interpreter
Victim advocate (non-governmental, includes domestic
violence, sexual assault, and dual)
Victim assistant (governmental, includes victim-witness
specialist/coordinator)
Other (specify):
TOTAL

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B

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PURPOSE AREAS

All grantees must complete this section.

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

Purpose Areas
Providing services for children and youth exposed to domestic violence, dating
violence, sexual assault, or stalking, which may include direct counseling, advocacy, or
mentoring, and must include support for the non-abusing parent or the child’s caretaker
Providing training, coordination, and advocacy for programs that serve children and
youth (such as Head Start, child care, and after-school programs) on how to safely and
confidentially identify children and families experiencing domestic violence and properly
refer them to programs that can provide direct services to the family and children, and
coordination with other domestic violence or other programs serving children exposed
to domestic violence, dating violence, sexual assault, or stalking that can provide
training and direct services

13. Program interest areas addressed by your grant
(In addition to the purpose areas identified above, the CEV Program Solicitation may have encouraged
several program interest areas. If your program addressed any of these interest areas during the current reporting period, list them below. Please note that these may change from year to year—you will
want to refer to your grant application and/or grant guidelines to answer this question.) (Maximum —
2,000 characters)

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C1

FUNCTION AREAS
Training

Were your CEV Program funds used for training activities during the current reporting period?
Check yes if CEV Program funds were used for training activities during the current reporting period.
Yes—answer question 14–18
No—skip to Section C2
14. Training events provided
(Report the total number of training events provided during the current reporting period that were
either provided by CEV Program-funded staff or directly supported by CEV Program funds. Training
provided to CEV Program-funded staff should not be counted.)
Total number of training events provided
15. Number of people trained
People trained

Schoolbased

Advocacy organization staff (NAACP, Children’s Defense Fund, etc.)
Attorneys/law students
Child care staff
Child protective services workers
Children’s advocates (not affiliated with CPS)
Corrections personnel (probation, parole, and correctional facilities)
Court personnel
Culturally specific organization staff (non-governmental, does not include
immigrant organization staff)
Educators (teachers, administrators, etc.)
Faith-based organization staff
Government agency staff (vocational rehabilitation, food stamps, TANF)
Health professionals (doctors, nurses—does not include SAFE/SANE)
Immigrant organization staff (non-governmental)
Interpreters/translators
Law enforcement officers
Legal services staff (does not include attorneys)
Mental health professionals
Multidisciplinary
Other school staff (administrative support staff, coaches, facilities staff, etc.
—does not include educators)
Prosecutors
Resource officers
Sexual assault nurse examiner/sexual assault forensic examiner (SANE/SAFE)

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Non-school
based

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15. Number of people trained (cont.)
People trained

Schoolbased

Non-school
based

Social service organization staff (non-governmental—food bank, homeless
shelter)
State or tribal domestic violence coalition staff (includes sexual assault,
domestic violence, and dual)
Tribal government/Tribal government agency staff
Victim advocates (non-governmental, includes sexual assault, domestic
violence, and dual )
Victim assistants (governmental, includes victim-witness advocates/
specialists/coordinators)
Volunteers
Youth organization staff (Boys & Girls Clubs, Boy Scouts, Girl Scouts)
Other (specify):
TOTAL
16. Training content areas
(Indicate all topics covered in training events provided or directly supported by your CEV Program funds
during the current reporting period. Check all that apply.)
Mandatory training topics
Underserved populations
Issues specific to CEV who:
Appropriate referrals for children exposed to
violence and their families
are African
How to identify children exposed to violence
are American Indian or Alaska Native
How to coordinate with programs serving
are Asian
children exposed to violence
are black or African American
are D/deaf or hard of hearing
Sexual assault, domestic violence,
dating violence, and stalking
are Hispanic or Latino
Advocate response
are homeless/runaway
Child(ren)’s indirect exposure to violence
are immigrants, refugees, or asylum seekers
Child(ren)’s development
are lesbian, gay, bisexual, transgender, or
intersex
Confidentiality
are Middle Eastern
Dating violence overview, dynamics,
are Native Hawaiian or Other Pacific Islander
and services
are sexually exploited
Domestic violence overview, dynamics,
belong to a particular religion/spiritual group
and services
(specify):
Mandatory reporting requirements
Parenting issues
have disabilities
Response to children and youth who are in
have limited English proficiency
foster care
have mental health issues
Response to youth who are incarcerated
live in rural areas
Response to children and youth who have
Other (specify):
been trafficked
Safety planning for victims/survivors
Safety planning for children/youth
Sexual assault overview, dynamics,
and services
Stalking overview, dynamics, and services
Other (specify):
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16. Training content areas (cont.)
Community response
Community response to CEV
Coordinated community response
Response teams (DART, DVRT, SART)
Technology safety for children and youth
Use of technology in victim services (TTY, ALD, relay services)
Other (specify):
17. (Optional) Additional information
(Use the space below to discuss the effectiveness of training activities funded or supported by your CEV
Program grant and to provide any additional information you would like to share about your training
activities beyond what you have provided in the data above. For example, an increase in referrals from
health and mental health providers after training on how to identify children exposed to violence.)
(Maximum — 2,000 characters)

18. Additional information —
­ staff development
(If your CEV Program funds were used for training staff, please describe the funded positions and
type[s] of training received. Include topics. For example, use of art therapy with children exposed to
domestic violence.) (Maximum — 2,000 characters)

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C2

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Coordinated Community Response
All grantees must complete this section.

19. Coordinated community response activities
(Check the appropriate boxes to indicate the agencies or organizations, even if they are not MOU
partners, you provided referrals to, received referrals from, coordinated with, and/or attended
meetings with during the current reporting period, according to the usual frequency of the interactions.
In the fourth column, indicate the agencies or organizations with which you have a memorandum of
understanding [MOU] for purposes of the CEV Program. In the last column, indicate the agencies or
organizations that are required partners for purposes of the CEV Program).
Referrals and
Meetings
MOU
Required
coordination
Agency/organization
partner
partner
Daily Weekly Monthly Weekly Monthly Quarterly
After-school program
Child care provider
Child protective services
Community-based
organization
Corrections (probation,
parole, and correctional
facilities for youth, juvenile
justice)
Court
Culturally specific
organization (non-governmental, does not include
immigrant organization staff)
Deaf organization
Disability organization
(non-governmental, nonresidential)
Domestic violence program
Dual sexual assault and
domestic violence program
Educational institution/
organization
Faith-based organization
Family planning organization
Government agency (not
CPS)
Head Start
Health organization (not
mental health)
Homeless/housing
organization
Immigrant organization
(non-governmental)
Job training organization

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19. Coordinated community response activities (cont.)
Referrals and
Meetings
coordination
Agency/organization
Daily Weekly Monthly Weekly Monthly Quarterly
Law enforcement agency

MOU
partner

Required
partner

Legal organization (legal
services, bar association,
law school)
LGBTI organization
Mental health organization
Prosecutor’s office
Sexual assault program
Social service organization
(non-governmental)
Tribal government/Tribal
government agency/Tribal
nonprofit
Youth organization (nongovernmental, Boys/Girls
Club, Boy/Girl Scouts)
Other (specify):

20. (Optional) Additional information
(Use the space below to discuss the effectiveness of coordinated community response [CCR] activities
funded or supported by your CEV Program grant and to provide any additional information you would
like to share about your CCR activities beyond what you have provided in the data above. Examples
might include an increase in the number of referrals between an elementary or after-school program
and a local domestic violence program as a result of your convening meetings; or, as the result of
meetings between the school district and the local domestic violence agency, the development of a
referral protocol and ongoing workgroup to ensure its implementation; or improved understanding
among child care providers about the resources available to children exposed to sexual assault,
domestic violence, dating violence, or stalking and their families; or greater coordination between
domestic violence and sexual assault programs and after-school programs after a needs assessment
identified gaps in services.) (Maximum — 2,000 characters)

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C3

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Policies

Were your CEV Program funds used to develop, substantially revise, or implement policies or protocols
during the current reporting period?
Check yes if CEV Program-funded staff developed, substantially revised, and/or implemented
policies or protocols, or if CEV Program funds directly supported the development, revision, and/or
implementation of policies or protocols.
Yes—answer question 21
No—skip to Section C4
21. Types of policies or protocols developed, substantially revised, and/or implemented during the
current reporting period (Check all that apply.)
Access to translators/interpreters
Appropriate response, identification, and
referral policies and procedures for CEV
Appropriate response to underserved
populations
Appropriate use of translators/interpreters
Confidentiality/information sharing
Coordinated community response
Culturally and linguistically appropriate
response to underserved populations
Develop, revise, or implement linguistically,
culturally, and community relevant services for
underserved populations
Develop, revise, or implement policies that
enhance the safety of children exposed
to violence and their non-abusing parent/
caregiver

Mandatory reporting
Mandatory training for staff and volunteers
Parental consent
Procedures regarding protection orders
issued on behalf of children, parents, and/or
caregivers
Protocols with police/security
Providing information to victims/survivors
about victim services
Safety planning for children and youth
Safety planning for non-abusing parent/
caregiver
Safe spaces for children
Other (specify):

22. (Optional) Additional information
(Use the space below to discuss the effectiveness of policies and protocols funded or supported
by your CEV Program grant and to provide any additional information you would like to share about
policies and protocols beyond what you have provided in the data above. Examples might include
increase in the number of referrals of children exposed to violence for counseling services following
implementation of a referral protocol between local child care programs and your domestic violence
agency, or an increase in non-abusing parents seeking protection orders for themselves and their
children following implementation of a policy on use of interpreters in parent meetings with Head Start
teachers.) (Maximum — 2,000 characters)

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C4

Products

Were your CEV Program funds used to develop, substantially revise, or distribute products during the
current reporting period?
Check yes if CEV Program-funded staff developed, revised, and/or distributed products, or if CEV
Program funds directly supported the development, revision, or distribution of products.
Yes—answer question 23
No—skip to Section D
23. Use of CEV Program funds for product development, substantial revision, and/or distribution
(Report the number of products developed, substantially revised, or distributed with CEV Program funds
during the current reporting period. Report the number of new products developed or substantially
revised during the current reporting period; the title/topic and intended audience for each product
developed, revised, and/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 during the current reporting period whether
or not they 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

Brochures

Manuals

Training
curricula

Training
materials

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Other
languages

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23. Use of CEV Program funds for product development, substantial revision, and/or distribution (cont.)
Products

Number
developed
or revised

Title/topic

Intended
audience

Number
used or
distributed

Videos/DVDs

Website (report
number of
page views
in the used
or distributed
column)
Other
(specify):

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Other
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D

VICTIM SERVICES

Were your CEV Program funds used to provide services to children and youth and to non-abusing parents
or caregivers during the current reporting period?
Check yes if CEV Program-funded staff provided victim services, or if CEV Program funds were used to
support victim services during the current reporting period.
Yes—answer question 24–38
No—skip to Section E
24. Number of child victims who were served, partially served, and child victims who were seeking
services but 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 child victim who requested or received services during
the current reporting period should be counted only once and in only one of the listed categories. For
purposes of this question, child victims have been directly subjected to a violent act of sexual assault,
dating violence, or stalking.)
Sexual
assault

Dating
violence

Stalking

A. Served: Child victims who received
the grant-funded service(s) requested, if
those services were funded by your CEV
Program grant
B. Partially served: Child victims who
received some grant-funded service(s),
but not all of the grant-funded services
requested, if those services were funded
by your CEV Program grant
TOTAL SERVED AND PARTIALLY SERVED
(24A + 24B)
C. Child victims of violence seeking
services who were not served: Child
victims who sought grant-funded services
and did not receive the grant-funded
service(s) requested, if those services
were funded by your CEV Program grant

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TOTAL

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25. Child victims’ relationships to offender by victimization

(For those child victims reported as served and partially served in 24, report the child victim’s
relationship to the offender by type of victimization. If a child experienced more than one type of
victimization and/or was victimized by more than one perpetrator, count the child 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 24]; the total number in the dating violence column must be at least
[insert sum of dating violence victims/survivors reported in 24]; and the total number in the stalking
column must be at least [insert sum of stalking victims reported in 24].
Number of child victim relationships to offender by victimization
Child victim’s relationship to
offender
Sexual assault
Dating violence
Stalking
Current or former spouse or intimate
partner of parent/caregiver
Family or household member
Current or former dating
relationship of parent/caregiver
Current or former dating
relationship of the child
Acquaintance (neighbor, peer, etc.)
Stranger
Relationship unknown
TOTAL
26. Number of children indirectly exposed to violence who were served, partially served, and those
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 child indirectly exposed to violence who
requested or received services during the current reporting period should be counted only once and in
only one of the listed categories. For purposes of this question, children indirectly exposed to violence
have been indirectly subjected to a violent act of sexual assault, domestic violence, dating violence, or
stalking.)
Sexual
Domestic
Dating
Stalking
TOTAL
assault
violence
violence
A. Served: Children indirectly exposed
to violence who received the service(s)
requested, if those services were funded
by your CEV Program grant
B. Partially served: Children indirectly
exposed to violence who received some
grant-funded service(s), but not all of
the services requested, if those services
were funded by your CEV Program grant
TOTAL SERVED AND PARTIALLY SERVED
(26A + 26B)
C. Child victims of violence seeking
services who were not served: Children
indirectly exposed to violence who
sought grant-funded services and did
not receive the service(s) requested, if
those services were funded by your CEV
Program grant

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27. Children indirectly exposed to violence relationships to offender by victimization

(For those children indirectly exposed to violence reported as served and partially served in 26, report
the child’s relationship to the offender by type of victimization. If a child indirectly exposed to violence
experienced more than one type of victimization and/or was victimized by more than one perpetrator,
count the child 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 26]; the total number in the
domestic violence column must be at least [insert sum of domestic violence victims reported in 26];
the total number in the dating violence column must be at least [insert sum of dating violence victims/
survivors reported in 26]; and the total number in the stalking column must be at least [insert sum of
stalking victims reported in 26].)
Number of children indirectly exposed to violence
relationships to offender by victimization
Child indirectly exposed to violence
relationship to offender
Sexual
Dating
Domestic
Stalking
assault
violence
violence
Current or former spouse or intimate
partner of parent/caregiver
Family or household member
Current or former dating relationship of
parent/caregiver
Acquaintance (schoolmate, peer, etc.)
Stranger
Relationship unknown
TOTAL
28. Reasons that children who are direct victims and children indirectly exposed to violence who were
seeking services were not served or were partially served (Check all that apply.)
Children
Child
indirectly
Reasons not served or partially served
victims
exposed to
violence
Conflict of interest
Did not meet statutory requirements
Hours of operation
Insufficient/lack of culturally appropriate services
Insufficient/lack of language capacity (including sign language)
Insufficient/lack of services for children who are D/deaf or hard of hearing
Insufficient/lack of services for children with disabilities
Program reached capacity
Program unable to provide services due to limited resources/priority-setting
Services inappropriate or inadequate for children with mental health issues
Services not appropriate for child
Transportation
Other (specify):

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29. Demographics of child victims and children indirectly exposed to violence served or partially served

(Based on the child victims reported in 24A and 24B and the children indirectly exposed to violence
reported in 26A and 26B, provide the total numbers for all that apply. Because individuals may identify
in more than one category of race/ethnicity, the total for “Race/ethnicity” may exceed the total number
of child victims reported in 24A and 24B or the number of children indirectly exposed to violence
reported in 26A and 26B. However, the total number of child victims reported under “Race/ethnicity”
should not be less than the total number of child victims reported in questions 24A and 24B and the
total number of children indirectly exposed to violence should not be less than the total number of
children indirectly exposed to violence reported in 26A and 26B. The total number of child victims of
violence reported under “Gender” and the total number reported under “Age” should equal the total
number of child victims of violence reported in questions 24A and 24B or the number of children
indirectly exposed to violence reported in 26A and 26B. Those victims for whom gender, age, and/or
race/ethnicity is not known should be reported in the “Unknown” category.)
Race/ethnicity (Children should be counted once in each
category of race/ethnicity that applies. Children should not
be counted more than once in either the category “American
Indian or Alaska Native” or in the category “Native Hawaiian
or Other Pacific Islander.”)

Number of child
victims
(from Q24)

American Indian or Alaska Native
Asian
Black or African American
Hispanic or Latino
Native Hawaiian or Other Pacific Islander
White
Unknown
TOTAL RACE/ETHNICITY (should not be less thanxxxxxxxxxx
for child victims, orxxxxxxxx for children indirectly exposed
to violence)
Gender
Female
Male
Unknown
TOTAL GENDER (should equalxxxxxxx for child victims, or
xxxxxxxfor children indirectly exposed to violence)
Age
0–12
13–17
Unknown
TOTAL AGE (should equalxxxxxxxxxfor child victims, or
xxxxxxxxxxfor children indirectly exposed to violence)

CEV Program Semi-annual Progress Report • 17 • Office on Violence Against Women

Number of
children indirectly
exposed to
violence
(from Q26)

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29. Demographics of child victims and children indirectly exposed to violence served or partially served

(cont.)
Other demographics

Number of child
victims
(from Q24)

Number of
children indirectly
exposed to
violence
(from Q26)

Children with disabilities
Children who are D/deaf or hard of hearing
Children with limited English proficiency
Children who are immigrants/refugees/asylum seekers
Children who live in rural areas
Children who are homeless/runaways
Children who are lesbian, gay, bisexual, transgender, or
intersex
Children with mental health issues
30. Services to child victims and children indirectly exposed to violence

(Report the number of child victims from 24A and 24B and children indirectly exposed to violence from
26A and 26B who received CEV Program-funded services during the current reporting period. Count
each child victim and each child indirectly exposed to violence only once for each type of service that
child received during the current reporting period; do not report the number of times that service was
provided to the child. The total for each type of service provided to children should not be higher than
the total of 24A and 24B, [insert total of 24A and 24B] for child victims and not higher than the total of
26A and 26B, [insert total of 26A and 26B] for children indirectly exposed to violence. Shelter services
should be reported in question 37.)
Number of
Number of child children indirectly
Type of service
victims
exposed to
(from Q24)
violence
(from Q26)
Child advocacy (Actions designed to help the child obtain
needed support, resources, or services, including health
care, safety planning, etc.)
Civil legal advocacy/court accompaniment (Assisting with
civil legal issues including preparing paperwork for a
protection order and accompanying child to a protection
order hearing, administrative hearing, or other civil court
proceeding. Does not include advocacy by attorneys and/or
paralegals)
Counseling services (Individual or group art/play therapy,
intervention, or treatment provided by a volunteer, peer, or
professional. Does NOT include parent-child counseling or
family therapy with abuser.)

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30. Services to child victims and children indirectly exposed to violence (cont.)
Type of service

Number of child
victims
(from Q24)

Number of
children indirectly
exposed to
violence
(from Q26)

Criminal justice advocacy/court accompaniment (Assisting
with criminal legal issues including notification of case
status, hearing dates, plea agreements, and sentencing
terms; preparing paperwork such as victim impact
statements; accompaniment 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
only crisis intervention that occurs in person and/or over
the telephone.)
Education advocacy (Advocacy to ensure that educational
needs of child are met, including the rights of homeless
children and youth to a barrier-free education)
Hospital/clinic/other medical response (Accompanying a
child to or meeting a child at a hospital, clinic, or medical
office)
Language services (Interpretation, translation)
Parent-child counseling or treatment intervention (Does
NOT include family therapy with abuser)
Transportation (Provision of transportation, either directly
or through bus passes, taxi fares, or other means of
transportation to school or counseling)
Other (specify):
31. Services for children

(Use the space below to describe in more detail the types of services [art therapy, parent and child
counseling, support groups, etc.] you provided to children with CEV funds during the current reporting
period.) (Maximum — 2,000 characters)

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32. Number of non-abusing parents/caregivers receiving support or referrals

(Report the unduplicated number of non-abusing parents/caregivers who received CEV Programfunded support and the unduplicated number who received referrals during the current reporting
period. Parents/caregivers may be counted in both categories, but should only be counted once per
reporting period in each category if appropriate. For purposes of this form, non-abusing parents/
caregivers have the primary responsibility for the child’s day-to-day care. Only non-abusing parents/
caregivers whose children receive CEV Program-funded services should be reported.)
Total number of non-abusing parents/caregivers Total number of non-abusing parents/caregivers
receiving support
receiving referrals
33. Support and/or referrals provided to non-abusing parents/caregivers

(Report the number of non-abusing parents and caregivers who received CEV Program-funded support
or referrals during the current reporting period. Count each non-abusing parent or caregiver only once
for each type of support, or referral for that type of support, that the non-abusing parent or caregiver
received during the current reporting period; do not report the number of times that support, or a
referral for that support, was provided to the parent or caregiver. Shelter services should be reported in
question 37.)
Non-abusing
Non-abusing
parents/
parents/
Type of support
caregivers
caregivers
receiving support receiving referrals
Advocacy (Actions designed to help with needed support,
resources, or services, including employment, housing,
health care, safety planning, etc.)
Case management
Child care
Civil legal advocacy/court accompaniment (Assisting
with preparing paperwork for a protection order
and accompaniment to a protection order hearing,
administrative hearing, or other civil court proceeding.
Does not include advocacy by attorneys and/or paralegals.)
Civil legal assistance (Civil legal services provided by an
attorney and/or a paralegal for limited matters of stay-away
or protection order proceedings or domestic violencerelated immigration issues)
Counseling services/support group (Individual or group
counseling or support provided by a volunteer, peer, or
professional)
Criminal justice advocacy/court accompaniment (Assisting
with criminal legal issues including notification of case
status, hearing dates, plea agreements, and sentencing
terms; preparing paperwork such as victim impact
statements; accompaniment 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)

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33. Support provided to non-abusing parents/caregivers (cont.)
Type of support

Non-abusing
Non-abusing
parents/
parents/
caregivers
caregivers
receiving support receiving referrals

Education advocacy
Employment counseling (Actions designed to assist with
obtaining employment, e.g., coaching on career options,
skills training, job searches, resume-writing, marketing, job
interviews, and presentation of employment)
Home visitation
Hospital/clinic/other medical accompaniment
(Accompanying a victim/survivor to a hospital, clinic, or
medical office)
Housing assistance
Language services (Interpretation, translation)
Material assistance (Providing clothing, food, personal
items, etc.)
Parent education or classes
Respite services (Providing periodic relief for the family or
non-abusing parent/caregiver)
Transportation (Provision of transportation, either directly
or through bus passes, taxi fares, or other means of
transportation)
Other (specify):

34. Home-based services

(If you provided services by visiting the home of a child/caregiver, describe the types of services/
support you provided in the home.) (Maximum — 2,000 characters)

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35. Comprehensive services

(If child victims, children indirectly exposed to violence, and non-abusing parents or caregivers received
other needed services or support for matters such as those listed in questions 30 or 32 from other
sources [i.e., from your organization but with non-CEV funds, or from another source, such as agencies
to whom you make referrals], describe those sources and the types of services and support provided.
If available, you may submit numbers or other data to demonstrate that those additional needs were
met.) (Maximum — 2,000 characters)

36. Youth services

(If you reported serving youth [over the age of 12], even though your special condition specifies that
you will serve only children [12 and younger], please explain the circumstances under which you
provided those services. For example, you served three siblings, ages 9, 12, and 15 years old. It
was very important for the family’s treatment to include the 15-year-old sibling in the treatment as
comparable services for youth are not available in your community.) (Maximum — 2,000 characters)

37. Shelter services

(Report the total number of non-abusing parents/caregivers and accompanying family members
who received emergency shelter services provided with CEV Program funds during the current
reporting period. This should be an unduplicated count for both non-abusing parents/caregivers and
accompanying family members. This means that each non-abusing parent/caregiver 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 to non-abusing parents/
caregivers and accompanying family members. The number of bed nights is computed by multiplying
the number of non-abusing parents/caregivers and accompanying 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 non-abusing parents/caregivers and accompanying family members. For example, one nonabusing parent 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

Non-abusing
parents/caregivers

Accompanying family
Number of bed nights
members

Emergency shelter

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38. Protection orders

(Report the total number of temporary and/or final protection orders requested and granted for which
CEV Program-funded victim services staff provided assistance to non-abusing parents/caregivers
and children or youth during the current reporting period. Indicate whether protection orders were
obtained for the non-abusing parent/caregiver, for the child or children, or for both. 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
Sexual assault
protection orders

Nonabusing
parent or
caregiver

Child(ren)
or youth

Final
Both

Nonabusing
parent or
caregiver

Child(ren)
or youth

Both

Number requested
Number granted
Temporary
Domestic violence
protection orders

Nonabusing
parent or
caregiver

Child(ren)
or youth

Final
Both

Nonabusing
parent or
caregiver

Child(ren)
or youth

Both

Number requested
Number granted
Temporary
Dating violence
protection orders

Nonabusing
parent or
caregiver

Child(ren)
or youth

Final
Both

Nonabusing
parent or
caregiver

Child(ren)
or youth

Both

Number requested
Number granted
Temporary
Stalking
protection orders

Nonabusing
parent or
caregiver

Child(ren)
or youth

Final
Both

Nonabusing
parent or
caregiver

Child(ren)
or youth

Number requested
Number granted

CEV Program Semi-annual Progress Report • 23 • Office on Violence Against Women

Both

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39. (Optional) Additional information

(Use the space below to discuss the effectiveness of services provided to child victims, children
exposed to violence, and non-abusing parents and caregivers that were funded or supported by your
CEV grant, and to provide any additional information you would like to share about these activities
beyond what you have provided in the data above. For example, parents and caregivers report that they
have seen improvements in the behavior of children indirectly exposed to violence who received grantfunded play therapy services or you have seen a significant increase in the number of parents and
caregivers who are including children in their protection orders.) (Maximum — 2,000 characters)

CEV Program Semi-annual Progress Report • 24 • Office on Violence Against Women

SECTION

E

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NARRATIVE

All grantees must answer question 40.
PLEASE LIMIT YOUR RESPONSES TO THE SPACE PROVIDED.
40. Report on the status of your CEV Program grant goals and objectives as of the end of the current
reporting period.

(Report succinctly on the status of the goals and objectives for your grant as of the end of the current
reporting period, as they were identified in your grant proposal or as they have been added or revised.
Indicate whether the activities related to your objectives for the current reporting period have been
completed, are in progress, are delayed, or have been revised. Comment briefly on your successes and
challenges, and provide any additional explanation you feel is necessary for us to understand what
you have or have not accomplished relative to your goals and objectives. If you have not accomplished
objectives that should have been accomplished during the current reporting period, you must provide
an explanation.)
All grantees must answer questions 41 and 42 on an annual basis. Submit this information on the
January to June reporting form only.
PLEASE LIMIT YOUR RESPONSES TO THE SPACE PROVIDED (8,000 CHARACTERS) FOR EACH QUESTION.
41. What do you see as the most significant areas of remaining need with regard to improving services
to children exposed to sexual assault, domestic violence, dating violence, and stalking, and
providing support for their non-abusing parents and caregivers?

(Consider geographic regions, underserved populations, service delivery systems, and/or challenges
and barriers unique to your service area and the population(s) you serve.)
42. What has CEV Program funding allowed you to do that you could not do prior to receiving this
funding?

(For example, we have been able to train staff at every after-school program in our city, or we have
been able to develop new partnerships with our local domestic violence and sexual assault programs,
leading to increased referrals from our childcare programs to these agencies.)
Questions 43 and 44 are optional.
PLEASE LIMIT YOUR RESPONSES TO THE SPACE PROVIDED (8,000 CHARACTERS) FOR EACH QUESTION.
43. Provide any additional information that you would like us to know about your CEV Program grant
and/or the effectiveness of your grant.

(If you have other data or information that you have not already reported in answer to previous
questions on this form that demonstrate the effectiveness of your CEV Program grant, please provide
it below. Feel free to discuss any of the following: systems-level changes, community collaboration, the
removal or reduction of barriers and challenges for children and victims/survivors, promising practices,
positive or negative unintended consequences. Refer to separate instructions for a fuller explanation
and examples.)
44. Provide any additional information that you would like us to know about the data submitted.

(If you have any information that could be helpful in understanding the data you have submitted in this
report, please answer this question. For example, if you submitted two different progress reports for
the same reporting period, you may explain how the data was apportioned to each report; or if your
CEV Program funds supported staff—e.g. victim advocates, child advocates, etc.—but did not report
any corresponding services, 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, 145 N Street NE
Washington, DC 20531.

CEV Program Semi-annual Progress Report • 25 • Office on Violence Against Women

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Report on the status of your CEV Program grant goals and objectives as of the end of the current reporting
period. Question 39
Status (100 characters)
Goals/objectives (1,750 characters)

Key activities (1,750 characters)

Comments (500 characters)

Status
Goals/objectives

Key activities

Comments

CEV Program Semi-annual Progress Report • 26 • Office on Violence Against Women

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Report on the status of your CEV Program grant goals and objectives as of the end of the current reporting
period. Question 39 (cont. 1)
Status
Goals/objectives

Key activities

Comments

Status
Goals/objectives

Key activities

Comments

CEV Program Semi-annual Progress Report • 27 • Office on Violence Against Women

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Report on the status of your CEV Program grant goals and objectives as of the end of the current reporting
period. Question 39 (cont. 2)
Status
Goals/objectives

Key activities

Comments

Status
Goals/objectives

Key activities

Comments

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What do you see as the most significant areas of remaining need with regard to improving services
to children exposed to sexual assault, domestic violence, dating violence, and stalking, and providing
support for their non-abusing parents and caregivers? (Consider geographic regions, underserved
populations, service delivery systems, and/or challenges and barriers unique to your service area and the
population[s] you serve.) Question 40

CEV Program Semi-annual Progress Report • 29 • Office on Violence Against Women

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Expiration Date:

What do you see as the most significant areas of remaining need with regard to improving services
to children exposed to sexual assault, domestic violence, dating violence, and stalking, and providing
support for their non-abusing parents and caregivers? (Consider geographic regions, underserved
populations, service delivery systems, and/or challenges and barriers unique to your service area and the
population[s] you serve.) Question 40 (cont.)

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What has CEV Program funding allowed you to do that you could not do prior to receiving this funding?
(For example, we have been able to train staff at every after-school program in our city, or we have been
able to develop new partnerships with our local domestic violence and sexual assault programs, leading to
increased referrals from our childcare programs to these agencies.) Question 41

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What has CEV Program funding allowed you to do that you could not do prior to receiving this funding?
(For example, we have been able to train staff at every after-school program in our city, or we have been
able to develop new partnerships with our local domestic violence and sexual assault programs, leading to
increased referrals from our childcare programs to these agencies.) Question 41 (cont.)

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Expiration Date:

Provide any additional information that you would like us to know about your CEV Program grant and/
or the effectiveness of your grant. (If you have other data or information that you have not already reported
in answer to previous questions on this form that demonstrate the effectiveness of your CEV Program
grant, please provide it below. Feel free to discuss any of the following: systems-level changes, community
collaboration, the removal or reduction of barriers and challenges for children and victims/survivors,
promising practices, positive or negative unintended consequences. Refer to separate instructions for a
fuller explanation and examples.) Question 42

CEV Program Semi-annual Progress Report • 33 • Office on Violence Against Women

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Expiration Date:

Provide any additional information that you would like us to know about your CEV Program grant and/
or the effectiveness of your grant. (If you have other data or information that you have not already reported
in answer to previous questions on this form that demonstrate the effectiveness of your CEV Program
grant, please provide it below. Feel free to discuss any of the following: systems-level changes, community
collaboration, the removal or reduction of barriers and challenges for children and victims/survivors,
promising practices, positive or negative unintended consequences. Refer to separate instructions for a
fuller explanation and examples.) Question 42 (cont.)

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Provide any additional information that you would like us to know about the data submitted. (If you have
any information that could be helpful in understanding the data you have submitted in this report, please
answer this question. For example, if you submitted two different progress reports for the same reporting
period, you may explain how the data was apportioned to each report; or if your CEV Program funds
supported staff—e.g. victim advocates, child advocates, etc.—but did not report any corresponding services,
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.)
Question 43

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Provide any additional information that you would like us to know about the data submitted. (If you have
any information that could be helpful in understanding the data you have submitted in this report, please
answer this question. For example, if you submitted two different progress reports for the same reporting
period, you may explain how the data was apportioned to each report; or if your CEV Program funds
supported staff—e.g. victim advocates, child advocates, etc.—but did not report any corresponding services,
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.)
Question 43 (cont.)

CEV Program Semi-annual Progress Report • 36 • Office on Violence Against Women