Form Youth Offender QPR Youth Offender QPR Youth Offender QPR

OMB No.

1205-XXXX

Expires:

Grant Number:

Project or Sub-Project ID/Number:

Report Quarter End Date:

Enrollment Goal:

Performance Items

Current Quarter (A)

Cumulative for Program Year (B)

Program-to-Date (C)

17 & Under

18 & Under

17 & Under

18 & Under

17 & Under

18 & Over

4a. Male

4b. Female

5a. Hispanic/Latino

5b. American Indian or Alaska Native

5c. Asian

5d. Black or African American

5e. Hawaiian Native or Other Pacific Islander

5f. White

6a1. High School Student at Time of Arrest

6a2. School Drop-out at Time of Arrest

6a3. H.S. Graduate/GED at Time of Arrest

6b1. High School Student at Time of Enrollment

6b2. School Drop-out at Time of Enrollment

6b3. H.S. Graduate/GED at Time of Enrollment

7a. From Correctional Facility

7b. From Detention

7c. From Probation/Diversion

8. Basic Skills Deficient

9. Foster Youth

10. Parent of a Child

11a. Stable Housing

11b. Temporary Housing

11c. Homeless

C. PROGRAM SERVICES, ACTIVITIES, AND OTHER RELATED ASSISTANCE

Performance Items

Current Quarter (A)

Cumulative for Program Year (B)

Program-to-Date (C)

17 & Below

18 & Above

17 & Below

18 & Above

17 & Below

18 & Above

Value

Numerator

Value

Numerator

Value

Numerator

Value

Numerator

Value

Numerator

Value

Numerator

Denominator

Denominator

Denominator

Denominator

Denominator

Denominator

1. Received Tutoring, Academic Counseling, ESL

2. Received Credit Retrieval Assistance

3. Twilight, Continuation, or Alternative School

4. GED Instruction

5. Vocational/Occupational Skills Training

6. College Bound Activities

7. Work Experience or Interrnship

8. Work Readiness Training or Career/Life Skills Couseling

9. Job Placement Services

10. Leadership Development

11. Community Service/Restorative Justice

12. Mentoring

13. Substance Abuse Treatment

14. Supportive Services

15. Received Any of the Above Services (Unduplicated)

D. SHORT-TERM INDICATORS OF PERFORMANCE

Leading Indicators of Performance

Performance Items

Current Quarter (A)

Cumulative for Program Year (B)

Program-to-Date (C)

Value

Numerator

Value

Numerator

Value

Numerator

Denominator

Denominator

Denominator

1. Enrollment Rate

2a. Participants Ages 17 and Below Who Return to School

2b. Participants Ages 17 and Below Who Remain in School 12 Months or More

2c. Participants Ages 17 and Below Who Receive H.S. Diploma or GED

3a. Out-of-School Participants Ages 18 and Above Placed in an Unsubsidized Job

3b. Out-of-School Participants Ages 18 and Above Placed in Post-Secondary Education

3c. Out-of-School Participants Ages 18 and Above Placed in Occupational Training Not Paid with DOL Funds

4a. Basic Skills Deficient Participants Who Increase at Least 1 Grade Level in Reading

4b. Basic Skills Deficient Participants Who Increase at Least 1 Grade Level in Math

5. Dismissal of Case after Diversion Program Participation

6. Expungement of Juvenile Record for those Receiving Legal Services

E. LONG-TERM INDICATORS OF PERFORMANCE

Common Performance Measures

1. Attainment of a Degree or Industry-Recognized Certificate (Age 18 & Above Only)

2. Literacy and Numeracy Attainment

3a. Out-of-School Participants Ages 18 and Above Placed in Unsubsidized Jobs, Post-Secondary Education, or Occupational Training

3b. Out-of-School Participants Ages 18 and Above Who Have Completed or Left the Program Placed in Unsubsidized Jobs, Post-Secondary Education, or Occupational Training

Additional Performance Measures

4. Recidivism Rate at 12 Months for Participants Ages 17 and Below

5. Recidivism Rate at 12 Months for Participants Ages 18 and Above

6. Working or Attending School at 3-Month Follow-Up

7. Working or Attending School at 6-Month Follow-Up

8. Working or Attending School at 9-Month Follow-Up

9. Working or Attending School at 12--Month Follow-Up

F. REPORT CERTIFICATION/ADDITIONAL COMMENTS

Grantee Remarks:

Email:

This reporting requirement is approved under the Paperwork Reduction Act of 1995, OMB Control No. 1205-XXXX. Persons are not required to respond to this collection of information unless it displays a currently valid OMB number. Public reporting burden for this collection of information is estimated to average 16 hours per quarterly report per grantee, including time for reviewing instructions, searching existing data sources, gathering and reviewing the collection of information. Respondent’s obligation to reply is required to maintain benefits. The reason for the collection of information is general program oversight, evaluation and performance assessment. Send comments regarding this burden estimate or any other aspect of this collection, including suggestions for reducing this burden, to the U. S. Department of Labor, Employment and Training Administration, Youth Office, Room N4459, 200 Constitution Avenue, NW, Washington, D.C. 20210 (Paperwork Reduction Project 1205-XXXX).