NGO Safe and Supportive Environment Measures

Form Approved

OMB No: 0920-XXXX

Exp. Date: XX/XX/XXXX

“Promoting Adolescent Health through School-Based HIV/STD Prevention”

Attachment 3b

NGO SSE Items

Public reporting burden of this collection of information is estimated to average 30 minutes per response, including the time for reviewing instructions, searching existing data sources, gathering and maintaining the data needed, and completing and reviewing the collection of information. An agency may not conduct or sponsor, and a person is not required to respond to a collection of information unless it displays a currently valid OMB control number. Send comments regarding this burden estimate or any other aspect of this collection of information, including suggestions for reducing this burden to CDC/ATSDR Reports Clearance Officer; 1600 Clifton Road NE, MS D-74, Atlanta, Georgia 30333; Attn: OMB-PRA (0920-New)

NGO Measures – SSE SEA

Measures

Questions for Collection of Measures

SSE Process Measure 1: % of funded SEAs that received assistance on SSE

In the past six months, how often did you interact with [FUNDED SEA NAME] to provide assistance (e.g., professional development events, technical assistance, guidance or resource materials, referrals to other agencies or organizations) on SSE? _____ Never _____ 1 time _____ 2 times _____ 3 - 5 times _____ 6 - 10 times _____ 11 - 15 times _____ 16 - 20 times _____ 21 or more times On what SSE topics did you provide assistance to [FUNDED SEA NAME]? (Check all that apply) Select strategies to prevent bullying, sexual harassment, and electronic aggression Implement strategies to prevent bullying, sexual harassment, and electronic aggression Select parent engagement strategies Implement parent engagement strategies Select school connectedness strategies Implement school connectedness strategies Assess safe and supportive environment policies Monitor the implementation of safe and supportive environment policies Manage controversy around safe and supportive environments Build staff and student competencies and techniques to promote a safe and supportive environment for all students

NGO Measures – SSE LEA

Measures

Questions for Collection of Measures

SSE Process Measure 1: % of funded LEAs that received assistance on SSE

In the past six months, how often did you interact with [FUNDED LEA NAME] to provide assistance (e.g., professional development events, technical assistance, guidance or resource materials, and referrals to other agencies or organizations) on SSE? _____ Never _____ 1 time _____ 2 times _____ 3 - 5 times _____ 6 - 10 times _____ 11 - 15 times _____ 16 - 20 times _____ 21 or more times On what SSE topics did you provide assistance to [FUNDED LEA NAME]? (Check all that apply) Select strategies to prevent bullying, sexual harassment, and electronic aggression Implement strategies to prevent bullying, sexual harassment, and electronic aggression Select parent engagement strategies Implement parent engagement strategies Select school connectedness strategies Implement school connectedness strategies Assess safe and supportive environment policies Monitor the implementation of safe and supportive environment policies Manage controversy around safe and supportive environments Build staff and student competencies and techniques to promote a safe and supportive environment for all students