Program Fidelity Checklist

MAKING PROUD CHOICES (MPC) SCHOOL EDITION CURRICULUM LOG SHEETS

Date: ______________________

FOR FACILITATORS

This packet contains 14 curriculum log sheets. Please complete the log sheet appropriate for each module you implement. These log sheets are a tool to document how much of the module you completed. If you wish to comment on any questions or explain your answers, feel free to write in the space in the margins.

FACILITATOR NAME: ____________________________________

Instructions: For each activity, indicate whether the activity was fully completed, partially completed, or not done at all. Place a check in the appropriate column.

Module 1 – Getting to Know You and Making Your Dreams Come True

ACTIVITY	NOT DONE	PARTIALLY COMPLETED	FULLY COMPLETED
A. Welcome and Program Overview
B. Talking Circle
C. Creating Group Agreements
D. Making Proud Choices: Be Proud! Be Responsible! Brainstorm
E. Goals and Dreams Timeline
F. Brainstorming Obstacles to Your Goals and Dreams

Did you add anything that was not a part of this module as written in the manual? ______Yes ______No

If yes, please describe what you added: _____________________________________________________________________________

_____________________________________________________________________________________________________________________

Did you make any other changes from the directions written in the facilitator’s manual? ______Yes ______No

If yes, please describe what changed and why. _______________________________________________________________________

_____________________________________________________________________________________________________________________

For each activity that you partially completed or did not complete, please indicate what was not completed and why: _________________________________________________________________________________________________________________________

_________________________________________________________________________________________________________________________

_________________________________________________________________________________________________________________________

Instructions: For each activity, indicate whether the activity was fully completed, partially completed, or not done at all. Place a check in the appropriate column.

Module 2 – The Consequences of Sex: HIV Infection: Part 1

ACTIVITY	NOT DONE	PARTIALLY COMPLETED	FULLY COMPLETED
A. The Subject Is HIV DVD and Discussion
B. Myths and Facts About HIV

Did you add anything that was not a part of this module as written in the manual? ______Yes ______No

If yes, please describe what you added: _____________________________________________________________________________

_____________________________________________________________________________________________________________________

Did you make any other changes from the directions written in the facilitator’s manual? ______Yes ______No

If yes, please describe what changed and why. _______________________________________________________________________

_____________________________________________________________________________________________________________________

For each activity that you partially completed or did not complete, please indicate what was not completed and why: _________________________________________________________________________________________________________________________

_________________________________________________________________________________________________________________________

_________________________________________________________________________________________________________________________

Instructions: For each activity, indicate whether the activity was fully completed, partially completed, or not done at all. Place a check in the appropriate column.

Module 3 – The Consequences of Sex: HIV Infection: Part 2

ACTIVITY	NOT DONE	PARTIALLY COMPLETED	FULLY COMPLETED
A. HIV Risk Continuum
B. Understanding Messages About Sex

Did you add anything that was not a part of this module as written in the manual? ______Yes ______No

If yes, please describe what you added: _____________________________________________________________________________

_____________________________________________________________________________________________________________________

Did you make any other changes from the directions written in the facilitator’s manual? ______Yes ______No

If yes, please describe what changed and why. _______________________________________________________________________

_____________________________________________________________________________________________________________________

For each activity that you partially completed or did not complete, please indicate what was not completed and why: _________________________________________________________________________________________________________________________

_________________________________________________________________________________________________________________________

_________________________________________________________________________________________________________________________

Instructions: For each activity, indicate whether the activity was fully completed, partially completed, or not done at all. Place a check in the appropriate column.

Module 4 – Attitudes About Sex, HIV and Condom Use

ACTIVITY	NOT DONE	PARTIALLY COMPLETED	FULLY COMPLETED
A. The Hard Way DVD and Discussion
B. Calling Koko: Part 1

Did you add anything that was not a part of this module as written in the manual? ______Yes ______No

If yes, please describe what you added: _____________________________________________________________________________

_____________________________________________________________________________________________________________________

Did you make any other changes from the directions written in the facilitator’s manual? ______Yes ______No

If yes, please describe what changed and why. _______________________________________________________________________

_____________________________________________________________________________________________________________________

For each activity that you partially completed or did not complete, please indicate what was not completed and why: _________________________________________________________________________________________________________________________

_________________________________________________________________________________________________________________________

_________________________________________________________________________________________________________________________

Instructions: For each activity, indicate whether the activity was fully completed, partially completed, or not done at all. Place a check in the appropriate column.

Module 5 – Strategies for Preventing HIV Infection: Stop, Think and Act: Part 1

ACTIVITY	NOT DONE	PARTIALLY COMPLETED	FULLY COMPLETED
A. Calling Koko: Part 2
B. STOP, THINK and ACT: Introduction to Problem Solving
C. Sean and Morgan Case Study: Problem Solving Using STOP, THINK and ACT

Did you add anything that was not a part of this module as written in the manual? ______Yes ______No

If yes, please describe what you added: _____________________________________________________________________________

_____________________________________________________________________________________________________________________

Did you make any other changes from the directions written in the facilitator’s manual? ______Yes ______No

If yes, please describe what changed and why. _______________________________________________________________________

_____________________________________________________________________________________________________________________

For each activity that you partially completed or did not complete, please indicate what was not completed and why: _________________________________________________________________________________________________________________________

_________________________________________________________________________________________________________________________

_________________________________________________________________________________________________________________________

Instructions: For each activity, indicate whether the activity was fully completed, partially completed, or not done at all. Place a check in the appropriate column.

Module 6 – Strategies for Preventing HIV Infection: Stop, Think and Act: Part 2

ACTIVITY	NOT DONE	PARTIALLY COMPLETED	FULLY COMPLETED
A. Nicole's Choice DVD and Discussion
B. The AIDS Basketball Game

Did you add anything that was not a part of this module as written in the manual? ______Yes ______No

If yes, please describe what you added: _____________________________________________________________________________

_____________________________________________________________________________________________________________________

Did you make any other changes from the directions written in the facilitator’s manual? ______Yes ______No

If yes, please describe what changed and why. _______________________________________________________________________

_____________________________________________________________________________________________________________________

For each activity that you partially completed or did not complete, please indicate what was not completed and why: _________________________________________________________________________________________________________________________

_________________________________________________________________________________________________________________________

_________________________________________________________________________________________________________________________

Instructions: For each activity, indicate whether the activity was fully completed, partially completed, or not done at all. Place a check in the appropriate column.

Module 7 – The Consequences of Sex: STDs: Part 1

ACTIVITY	NOT DONE	PARTIALLY COMPLETED	FULLY COMPLETED
A. STD Facts OR The Subject Is STDs DVD
B. The Transmission Game

Did you add anything that was not a part of this module as written in the manual? ______Yes ______No

If yes, please describe what you added: _____________________________________________________________________________

_____________________________________________________________________________________________________________________

Did you make any other changes from the directions written in the facilitator’s manual? ______Yes ______No

If yes, please describe what changed and why. _______________________________________________________________________

_____________________________________________________________________________________________________________________

For each activity that you partially completed or did not complete, please indicate what was not completed and why: _________________________________________________________________________________________________________________________

_________________________________________________________________________________________________________________________

_________________________________________________________________________________________________________________________

Instructions: For each activity, indicate whether the activity was fully completed, partially completed, or not done at all. Place a check in the appropriate column.

Module 8 – The Consequences of Sex: STDs: Part 2

ACTIVITY	NOT DONE	PARTIALLY COMPLETED	FULLY COMPLETED
A. Discussing HIV and AIDS
B. What I Think About HIV/STD and Safer Sex
C. Condom Use Skills

Did you add anything that was not a part of this module as written in the manual? ______Yes ______No

If yes, please describe what you added: _____________________________________________________________________________

_____________________________________________________________________________________________________________________

Did you make any other changes from the directions written in the facilitator’s manual? ______Yes ______No

If yes, please describe what changed and why. _______________________________________________________________________

_____________________________________________________________________________________________________________________

For each activity that you partially completed or did not complete, please indicate what was not completed and why: _________________________________________________________________________________________________________________________

_________________________________________________________________________________________________________________________

_________________________________________________________________________________________________________________________

Instructions: For each activity, indicate whether the activity was fully completed, partially completed, or not done at all. Place a check in the appropriate column.

Module 9 – The Consequences of Sex: Pregnancy: Part 1

ACTIVITY	NOT DONE	PARTIALLY COMPLETED	FULLY COMPLETED
A. Brainstorming About Teens and Sex
B. Myths and Facts About Pregnancy
C. Tanisha & Shay DVD

Did you add anything that was not a part of this module as written in the manual? ______Yes ______No

If yes, please describe what you added: _____________________________________________________________________________

_____________________________________________________________________________________________________________________

Did you make any other changes from the directions written in the facilitator’s manual? ______Yes ______No

If yes, please describe what changed and why. _______________________________________________________________________

_____________________________________________________________________________________________________________________

For each activity that you partially completed or did not complete, please indicate what was not completed and why: _________________________________________________________________________________________________________________________

_________________________________________________________________________________________________________________________

_________________________________________________________________________________________________________________________

Instructions: For each activity, indicate whether the activity was fully completed, partially completed, or not done at all. Place a check in the appropriate column.

Module 10 – The Consequences of Sex: Pregnancy: Part 2

ACTIVITY	NOT DONE	PARTIALLY COMPLETED	FULLY COMPLETED
A. Birth Control Methods Demonstration
B. Agree/Disagree—Attitudes About Contraception

Did you add anything that was not a part of this module as written in the manual? ______Yes ______No

If yes, please describe what you added: _____________________________________________________________________________

_____________________________________________________________________________________________________________________

Did you make any other changes from the directions written in the facilitator’s manual? ______Yes ______No

If yes, please describe what changed and why. _______________________________________________________________________

_____________________________________________________________________________________________________________________

For each activity that you partially completed or did not complete, please indicate what was not completed and why: _________________________________________________________________________________________________________________________

_________________________________________________________________________________________________________________________

_________________________________________________________________________________________________________________________

Instructions: For each activity, indicate whether the activity was fully completed, partially completed, or not done at all. Place a check in the appropriate column.

Module 11 – Developing Condom Use and Negotiation Skills: Part 1

ACTIVITY	NOT DONE	PARTIALLY COMPLETED	FULLY COMPLETED
A. Condom Line-Up
B. How to Make Condoms Fun and Pleasurable
C. Barriers to Condom Use/ Condom Pros and Cons

Did you add anything that was not a part of this module as written in the manual? ______Yes ______No

If yes, please describe what you added: _____________________________________________________________________________

_____________________________________________________________________________________________________________________

Did you make any other changes from the directions written in the facilitator’s manual? ______Yes ______No

If yes, please describe what changed and why. _______________________________________________________________________

_____________________________________________________________________________________________________________________

For each activity that you partially completed or did not complete, please indicate what was not completed and why: _________________________________________________________________________________________________________________________

_________________________________________________________________________________________________________________________

_________________________________________________________________________________________________________________________

Instructions: For each activity, indicate whether the activity was fully completed, partially completed, or not done at all. Place a check in the appropriate column.

Module 12 – Developing Condom Use and Negotiation Skills: Part 2

ACTIVITY	NOT DONE	PARTIALLY COMPLETED	FULLY COMPLETED
A. “What to Say if My Partner Says...”: Responding to Excuses
B. Introduction to SWAT and Scripted Roleplays

Did you add anything that was not a part of this module as written in the manual? ______Yes ______No

If yes, please describe what you added: _____________________________________________________________________________

_____________________________________________________________________________________________________________________

Did you make any other changes from the directions written in the facilitator’s manual? ______Yes ______No

If yes, please describe what changed and why. _______________________________________________________________________

_____________________________________________________________________________________________________________________

For each activity that you partially completed or did not complete, please indicate what was not completed and why: _________________________________________________________________________________________________________________________

_________________________________________________________________________________________________________________________

_________________________________________________________________________________________________________________________

Instructions: For each activity, indicate whether the activity was fully completed, partially completed, or not done at all. Place a check in the appropriate column.

Module 13 – Enhancing Refusal and Negotiation Skills: Part 1

ACTIVITY	NOT DONE	PARTIALLY COMPLETED	FULLY COMPLETED
A. Safer Sex Negotiation Skills and Wrap It Up DVD
B. Practicing and Enhancing Negotiation Skills: Unscripted Roleplays: Part 1

Did you add anything that was not a part of this module as written in the manual? ______Yes ______No

If yes, please describe what you added: _____________________________________________________________________________

_____________________________________________________________________________________________________________________

Did you make any other changes from the directions written in the facilitator’s manual? ______Yes ______No

If yes, please describe what changed and why. _______________________________________________________________________

_____________________________________________________________________________________________________________________

For each activity that you partially completed or did not complete, please indicate what was not completed and why: _________________________________________________________________________________________________________________________

_________________________________________________________________________________________________________________________

_________________________________________________________________________________________________________________________

Instructions: For each activity, indicate whether the activity was fully completed, partially completed, or not done at all. Place a check in the appropriate column.

Module 14 – Enhancing Refusal and Negotiation Skills: Part 2

ACTIVITY	NOT DONE	PARTIALLY COMPLETED	FULLY COMPLETED
A. Practicing and Enhancing Negotiation Skills: Unscripted Roleplays: Part 2
B. Talking to Your Partner About Condom Use
C. Talking Circle

Did you add anything that was not a part of this module as written in the manual? ______Yes ______No

If yes, please describe what you added: _____________________________________________________________________________

_____________________________________________________________________________________________________________________

Did you make any other changes from the directions written in the facilitator’s manual? ______Yes ______No

If yes, please describe what changed and why. _______________________________________________________________________

_____________________________________________________________________________________________________________________

For each activity that you partially completed or did not complete, please indicate what was not completed and why: _________________________________________________________________________________________________________________________

_________________________________________________________________________________________________________________________

_________________________________________________________________________________________________________________________