Form 1122-0013 Semiannual Progress Report for the Rural Sexual Assault,

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U.S. Department of Justice
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SEMI-ANNUAL PROGRESS REPORT FOR
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Brief Instructions: This form must be completed for each Rural Domestic Violence, Dating Violence,
Sexual Assault, and Stalking Assistance Program (Rural Program) grant received. A grant administrator
or coordinator must ensure that the form is completed. Grant partners, however, may complete sections
relevant to their portion of the grant. Grant administrators or coordinators are responsible for compiling and
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All grantees should read each section to determine which questions they must answer, based on activities
supported under this grant during the current reporting period. Following are some guidelines regarding
which sections of the form must be completed by Rural Program grantees.
• All grantees must complete sections B and F and subsections A1 and C3.
• In sections D, E, and subsections A2, C1, C2, and C4-C8, grantees must answer an initial question
about whether they engaged in certain activities during the current reporting period. If the response is
yes, then the grantee must complete that section or subsection. If the response is no, the rest of that
section or subsection is skipped.
For example,
1. If you are a victim services agency providing training, coordinated community response and victim
services with staff funded under this grant, you would complete sections A1, A2, B, C1, C3, D, and F
(and answer “no” in subsections C2, C4-C8 and section E).
2. If you receive funds for training, coordinated community response, victim services, and law
enforcement, you would complete sections A1, A2, B, C1, C3, D, E1, and F (and answer “no” in
subsections C2, C4-C8 and E2-E5).
The activities of volunteers or interns should be reported if they were coordinated or supervised by Rural
Program-funded staff or if Rural Program funds substantially supported their activities.
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Section A:
A1:
A2:
Section B:
Section C:
C1:
C2:
C3:
C4:
C5:
C6:
C7:
C8:

SECTION
General Information
Grant Information
Staff Information
Purpose Areas
Function Areas
Training
Community Education
Coordinated Community Response
Policies
Products
Data Collection and Communication Systems
Specialized Units
System Improvements

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1
1
3
4
5
5
9
11
14
17
19
20
21

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Section D:
Section E:
E1:
E2:
E3:
E4:
E5:
Section F:

SECTION
Victim Services/Legal Services
Criminal Justice System
Law Enforcement
Prosecution
Courts
Probation and Parole
Batterer Intervention Program
Narrative

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22
34
34
37
43
47
50
51

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SECTION

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$

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Grant Information

All grantees must complete this subsection.
(format date with 6 digits – 01/31/04)

1.

Date of report

2.

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3.

Grantee name

4.

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(the federal grant number assigned to your Rural Program grant)

5.

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(Check the one answer that best describes the type of agency/organization administering Rural
Program funds. States administering Rural Program funds should see the separate instructions for
additional information.)
Court
Government agency (e.g. state criminal justice agency, child protective services)
Law enforcement
Legal services organization
Probation, parole, or other correctional agency
Prosecution
State coalition
Tribal government
Unit of local government
University/school
Victim services (domestic violence)
Victim services (dual – domestic violence/sexual assault)
Victim services (sexual assault)
Other (specify):

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January 1 – June 30

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6.

Yes

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No

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

MI

Last name

Agency/organization name
Address
City

State

Telephone

Facsimile

Zip code

E-mail

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(Year)

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7.

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(Check yes if your Rural Program grant focuses on tribal populations, and indicate which tribes or
nations you serve or intend to serve.)

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Yes

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No

,I\HV which tribes/nations:

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(Report the area[s] addressed by your Rural Program grant during the current reporting period and
estimate the approximate percentage of funds [or resources] used to address each area [consider
education, training, victim services, etc.]. The grantee may choose how to make this determination.)
Throughout this form, the term VH[XDODVVDXOW means any nonconsensual sexual act proscribed by
Federal, tribal, or State law, including when the victim lacks capacity to consent. The term domestic
YLROHQFHGDWLQJYLROHQFH 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 or dating partner. 6WDONLQJLVGHÀQHGDV
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fear for his or her safety or the safety of others, or suffer substantial emotional distress. &KLOGVH[XDO
DEXVH includes sexual assaults committed against children under the age of 13. See the separate
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Sexual assault

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Domestic violence/dating violence

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Stalking

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Child sexual abuse

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0

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Staff Information

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Check yes if Rural Program funds were used to pay staff, including part-time staff and contractors.
Yes—answer question 10
No—skip to section B

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10. Staff
(Report the total number of full-time equivalent [FTE] staff funded by the Rural 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 fulltime administrator in October who was 100% funded with Rural Program funds, you would report that
as .5 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 FTEs.)
Staff
Administrator H[HFXWLYHGLUHFWRUÀVFDOPDQDJHU
Attorney (does not include prosecutor)
Children’s advocate
Counselor
Court personnel
Information technology staff
Investigator (prosecution-based)
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Legal advocate (does not include attorney or paralegal)
Outreach worker
Paralegal
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Program coordinator (training coordinator, victim services coordinator,
project coordinator, contract coordinator, clinical coordinator, volunteer
coordinator)
Prosecutor
Sexual assault forensic examiner/sexual assault nurse examiner
(SAFE/SANE)
Support staff (administrative assistant, bookkeeper, accountant)
Trainer/educator
Translator/interpreter
Victim advocate (non-governmental, includes domestic violence, sexual
assault, and dual)
Victim assistant (governmental, includes victim-witness specialist/
coordinator)
Other (specify):
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SECTION

B

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385326($5($6

All grantees must complete this section.

11. 3XUSRVHDUHDVVWUDWHJLHV
(Check all purpose areas that apply to activities supported by Rural Program funds during the current
reporting period.)
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To implement, expand, and establish cooperative efforts and projects among law
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to investigate and prosecute incidents of domestic violence, dating violence, sexual
assault, and stalking, including developing multidisciplinary teams focusing on high
risk cases with the goal of preventing domestic and dating violence homicides.
To provide treatment, counseling, advocacy, legal assistance, and other long-term
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domestic violence, dating violence, sexual assault, and stalking in rural communities,
including assistance in immigration matters.
To work in cooperation with the community to develop education and prevention
strategies directed toward such issues.
To develop, enlarge, or strengthen programs addressing sexual assault, including
sexual assault forensic examiner programs, Sexual Assault Response Teams, law
enforcement training, and programs addressing rape kit backlogs.
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domestic violence, dating violence, sexual assault, and stalking who reside in remote
rural and geographically isolated areas, including addressing the challenges posed
by the lack of access to shelters and victim services, and limited law enforcement
resources and training, and providing training and resources to Community Health
Aides involved in the delivery of Indian Health Service programs.

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If your program addressed any of these priority areas during the current reporting period, list them
below.)

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SECTION

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C1

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7UDLQLQJ

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Check yes if Rural Program-funded staff provided training or if Rural Program funds directly supported the
training.
Yes—answer questions 13-16
No—skip to C2

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For the purposes of this reporting form, WUDLQLQJ means providing information on sexual assault, domestic
violence, dating violence, stalking, and child sexual abuse that enables professionals to improve their
response to victims/survivors as it relates to their role in the system. Education means providing general
information that will increase public awareness of sexual assault, domestic violence, dating violence,
stalking, and child sexual abuse. In this subsection, report information on training activities. Education
should be reported in subsection C2.
13. 7UDLQLQJHYHQWVSURYLGHG
(Report the total number of training events provided during the current reporting period that were
either provided by Rural Program-funded staff or directly supported by Rural Program funds. Training
provided to Rural Program-funded staff should not be counted.)
Total number of training events provided
14. 3HRSOHWUDLQHG
(Report the number of people trained during the current reporting period by Rural Program-funded
staff or training supported by Rural Program funds. Use the category that is most descriptive of the
people who attended the training event. Rural Program-funded staff attending training should not be
counted. Students, community members, and victims should not be reported as people trained, since
they are not professionals responding to victims.)
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Advocacy organization staff (NAACP, AARP)
Attorneys/law students
Batterer intervention program staff
Child care staff
Child protective service workers
Children’s advocates QRWDIÀOLDWHGZLWK&36
Corrections personnel (probation, parole, and correctional facilities)
Court personnel (non-tribal)
Court personnel (tribal)
Educators (teachers, administrators, etc.)
Faith-based organization staff
Government agency staff (vocational rehabilitation, food stamps, TANF)
Health professionals (doctors, nurses, community health aides—does not
include SAFE/SANE)
Immigrant organization staff (non-governmental)
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Interpreters/translators
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Legal services staff (does not include attorneys)
Mental health professionals
Prosecutors (non-tribal)
Prosecutors (tribal)
Sexual assault forensic examiner/sexual assault nurse examiner
(SAFE/SANE)
Social service organization staff (non-governmental—food bank,
homeless shelter)
State or tribal coalition staff (includes sexual assault, domestic violence,
and dual)
Tribal government/Tribal government agency staff
Victim advocates (non-tribal, non-governmental, includes sexual assault,
domestic violence, and dual )
Victim advocates (tribal, includes sexual assault, domestic violence,
and dual)
Victim assistants (non-tribal, includes victim-witness specialists/
coordinators)
Victim assistants (tribal, includes victim-witness specialists/coordinators)
Volunteers
Other (specify):
727$/

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1XPEHU

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15. 7UDLQLQJFRQWHQWDUHDV
(Indicate all topics covered in training events provided or directly supported by your Rural Program
funds during the current reporting period. Check all that apply.)

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Protection orders (including full faith and
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crevdit)
Advocate response
Sexual assault forensic examination
Child development
Sexual assault statutes/codes
Child sexual abuse overview, dynamics,
Stalking statutes/codes
and services
Tribal jurisdiction and Public Law 280
Child witnesses
Other (specify):
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Dating violence overview, dynamics, and
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services
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Domestic violence overview, dynamics,
are American Indian or Alaska Native
and services
are Asian
Mandatory reporting requirements
are Black or African American
Parenting issues
are elderly
Response to victims/survivors who are
are geographically isolated
incarcerated
are Hispanic or Latino
Response to victims/survivors who have
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are homeless or living in poverty
Safety planning for victims/survivors
are immigrants, refugees, or asylum
seekers
Sexual assault overview, dynamics, and
services
are lesbian, gay, bisexual, transgender, or
intersex
Stalking overview, dynamics, and services
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Other (specify):
Islander
Justice system
have disabilities
Child sexual abuse statutes/codes
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Civil court procedures
have mental health issues
Criminal court procedures
have substance abuse issues
Decreasing dual arrests/identifying
Other (specify):
predominant aggressor
Domestic violence statutes/codes
Family court procedures
Community response
Firearms and domestic violence
Community response to sexual assault
Homicide prevention (lethality assessment)
Coordinated community response
Immigration
Response teams (DART, DVRT, SART)
Judicial response
Technology
Juvenile court procedures
Other (specify):
Law enforcement response
Pro-arrest policies
Probation response
Prosecution response

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16. 2SWLRQDO$GGLWLRQDOLQIRUPDWLRQ
(Use the space below to discuss the effectiveness of training activities funded or supported by your
Rural 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. Examples might include a
reduction in dual arrest rates following training provided on identifying the predominant aggressor;
improved system response to victims/survivors with disabilities following a multidisciplinary training
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survivors with disabilities. If you have facilitated a multidisciplinary training event(s) – different
professionals attending the same training - with Rural Program funds during the current reporting
period, you may elaborate here.) (Maximum – 2000 characters)

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C2

Community Education

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Check yes if Rural Program-funded staff engaged in community education activities or if Rural Program funds
directly supported community education.
Yes—answer questions 17-19
No—skip to C3

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For the purposes of this reporting form, education means providing general information that will increase
public awareness of sexual assault, domestic violence, dating violence, stalking, and child sexual abuse.
7UDLQLQJ means providing information on sexual assault, domestic violence, dating violence, stalking, and
child sexual abuse that enables professionals to improve their response to victims/survivors as it relates to
their role in the system. In this subsection, report information on community education activities. Training
should be reported in subsection C1.
17. (GXFDWLRQHYHQWV
(Report the total number of education events provided during the current reporting period that were
either provided by Rural Program-funded staff or directly supported with Rural Program funds.)
Total number of education events provided
18. 3HRSOHHGXFDWHGZLWK5XUDO3URJUDPIXQGV
(Report the number of people attending community education events during the current reporting
period. Use the category that is most descriptive of the people who attended the event.)
3HRSOHDWWHQGLQJHYHQW

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Child care providers
Community advocacy groups (NAACP, AARP)
Community businesses (retail stores, pharmacies)
Community groups (service or social groups)
Community membersXQDIÀOLDWHGDGXOWV
Educators (teachers, administrators, etc.)
Elementary school students
Faith-based groups
Middle and high school students
Parents or guardians
University or college students
Victims/survivors (do not count psychoeducation groups)
Other (specify):

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19. 7RSLFVRIHGXFDWLRQHYHQWVSURYLGHGZLWK5XUDO3URJUDPIXQGV
(Indicate all topics covered in education events provided with your Rural Program funds during the
current reporting period. Check all that apply.)
6H[XDODVVDXOWGRPHVWLFYLROHQFHGDWLQJYLROHQFHVWDONLQJDQGFKLOGVH[XDODEXVH
Child sexual abuse overview, dynamics, and services
Child sexual abuse prevention program
Dating violence overview, dynamics, and services
Domestic violence overview, dynamics, and services
Domestic violence/dating violence prevention program
Healthy relationships/domestic violence/dating violence prevention (6-12th grade)
Healthy relationships/domestic violence/dating violence prevention (community)
Healthy relationships/domestic violence/dating violence prevention (university)
Indigenous prevention programs
Mandated reporting of child sexual abuse
Parent-child interaction (parent-child play program, parent-child music class)
Parenting skills (child development, appropriate interventions)
Safety planning
Sexual assault overview, dynamics, and services
Stalking overview, dynamics, and services
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Other (specify):

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are American Indian or Alaska Native
are Asian
are Black or African American
are elderly
are geographically isolated
are Hispanic or Latino
are homeless or living in poverty
are immigrants, refugees, or asylum seekers
are lesbian, gay, bisexual, transgender, or intersex
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have disabilities
have mental health issues
have substance abuse issues
Other (specify):

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SECTION

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C3

Coordinated Community Response
All grantees must complete this subsection.

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Advocacy organization
(NAACP, AARP)
Batterer intervention
program
Child protective
services
Children’s advocacy
program
Corrections
(probation, parole, and
correctional facility)
Court (non-tribal)
Court (tribal)
Domestic violence
program (non-tribal)
Domestic violence
program (tribal)
Educational institution
Faith-based
organization
Government agency
(Social Security, TANF)
Health/mental health
organization (including
Indian Health Services)

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Response Team

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assistance

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20. &RRUGLQDWHGFRPPXQLW\UHVSRQVHDFWLYLWLHV
(Check the appropriate boxes to indicate the agencies or organizations, even if they are not partners
with which you have a memorandum of understanding [MOU], that you provided victim/survivor
referrals to, received victim/survivor referrals from, engaged in consultation with, provided technical
assistance to, and/or attended meetings with, during the current reporting period, according to the
usual frequency of the interactions. If the interactions were not part of a regular schedule, you will
need to estimate the frequency with which these interactions occurred during the current reporting
period. In the last three columns, indicate the agencies or organizations with which you have an MOU
for purposes of the Rural Program grant, as well as any agencies and organizations that are part of
a Rural Program-funded DV Homicide Prevention Team or Sexual Assault Response Team. If Rural
Program-funded staff participated in a task force or work group, indicate that under “Meetings” by
checking the frequency of the meeting and the types of organizations participating.)

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Immigration
organization
Law enforcement
agency (non-tribal)
Law enforcement
agency (tribal)
Legal organization
(legal services, bar
associations, law
school)
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(non-tribal)
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(tribal)
Sexual assault program
(non-tribal)
Sexual assault program
(tribal)
Sex offender
management/sex
offender treatment
provider
Social service
organization (nongovernmental)
Tribal government/
Tribal government
agency
Other (specify):

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Response Team

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Team

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assistance

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Expiration Date:

21. 2SWLRQDO$GGLWLRQDOLQIRUPDWLRQ
(Use the space below to discuss the effectiveness of coordinated community response [CCR] activities
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like to share about your CCR activities beyond what you have provided in the data above. Examples
might include an improved judicial response to custody issues involving victims/survivors of domestic
violence and their children, following meetings of a regional task force that included victim advocates,
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result of meetings between the governmental and non-governmental advocates; or an increase in
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prevention team made up of victim advocates, victim assistants, law enforcement, and prosecutors.)
(Maximum – 2000 characters)

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SECTION

C4

OMB Clearance #
Expiration Date:

3ROLFLHV

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Check yes if Rural Program-funded staff developed, substantially revised, and/or implemented policies or
protocols, or if Rural Program funds directly supported the development, revision, and/or implementation of
policies or protocols.
Yes—answer questions 22-23
No—skip to C5

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Staff, board, and/or volunteers represent
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response to underserved
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primary aggressor/discouraging
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access to protection order
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training on domestic violence/
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domestic violence/dating violence, sexual
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charge to victims/survivors for
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response to underserved
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assault, domestic violence/dating violence,
stalking, or child sexual abuse
No victims/survivors polygraphed
Policies to protect victims/survivors
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Expiration Date:

22. 7\SHVRISURWRFROVRUSROLFLHVGHYHORSHGFRQW
Courts

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response or accompaniment to
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emergency room
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exams not billed to victim/survivor
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screening and referrals for sexual
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Accelerated trial schedules
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Mandatory training on domestic violence/
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No charge to victims/survivors for any
costs related to the prosecution or
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assault, domestic violence/dating violence,
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from Internet disclosure of identifying
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response to underserved
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OMB Clearance #
Expiration Date:

23. 2SWLRQDO$GGLWLRQDOLQIRUPDWLRQ
(Use the space below to discuss the effectiveness of policies you have developed or implemented that
were funded or supported by your Rural Program grant and to provide any additional information you
would like to share about your activities beyond what you have provided in the data above. An example
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SECTION

OMB Clearance #
Expiration Date:

C5

3URGXFWV

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Check yes if Rural Program-funded staff developed or revised products or if Rural Program funds directly
supported the development or revision of products.
Yes—answer question 24
No—skip to C6

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24. 8VHRI5XUDO3URJUDPIXQGVIRUSURGXFWGHYHORSPHQWRUVXEVWDQWLDOUHYLVLRQ
(Report the number of products developed or substantially revised with Rural 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 of each product developed or
revised. If a product was created in or translated into a language other than English, including Braille,
indicate the language. 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. See separate
instructions for examples of how to report under “Number developed or revised.”)

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Intended
audience

Brochures

Flyers

Manuals

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OMB Clearance #
Expiration Date:

24. 8VHRI5XUDO3URJUDPIXQGVIRUSURGXFWGHYHORSPHQWRUVXEVWDQWLDOUHYLVLRQFRQW
3URGXFWV

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Intended
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Training curricula and
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Videos

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SECTION

C6

OMB Clearance #
Expiration Date:

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:HUH\RXU5XUDO3URJUDPIXQGVXVHGIRUGDWDFROOHFWLRQV\VWHPVRUFRPPXQLFDWLRQV\VWHPVRUIRUWKH
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Check yes if Rural Program funds or Rural Program-funded staff were used to develop, install, or expand data
collection and/or communication systems.
Yes—answer questions 25-26
No—skip to section C7

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(Check all that apply.)

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SECTION

OMB Clearance #
Expiration Date:

C7

6SHFLDOL]HG8QLWV

:HUH\RXU5XUDO3URJUDPIXQGVXVHGIRUVSHFLDOL]HGXQLWVGXULQJWKHFXUUHQWUHSRUWLQJSHULRG"
Check yes if any Rural Program-funded staff were part of a specialized unit in any of the categories listed
below, or if Rural Program funds were used to directly support a specialized unit. (A specialized unit is a
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and child sexual abuse cases. A specialized unit may consist of one person, even if that person is partially
funded by your Rural Program grant.
Yes—answer questions 27A-27B
No—skip to section C8

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27a. 8VHRI5XUDO3URJUDPIXQGVIRUVSHFLDOL]HGXQLWV
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(Check all victimizations addressed by your specialized unit(s) during the current reporting period.)
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Sexual assault
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SECTION

OMB Clearance #
Expiration Date:

C8

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:HUH\RXU5XUDO3URJUDPIXQGVXVHGIRUV\VWHPLPSURYHPHQWGXULQJWKHFXUUHQWUHSRUWLQJSHULRG"
Check yes if any Rural Program-funded staff engaged in system improvement activities or if Rural Program
funds directly supported system improvements (e.g. interpreters, safety audits, security).
Yes—answer questions 28
No—skip to section D

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28. 8VHRI5XUDO3URJUDPIXQGVIRUV\VWHPLPSURYHPHQW
(Check all that apply for the current reporting period.)
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enforcement

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SECTION

D

OMB Clearance #
Expiration Date:

9,&7,06(59,&(6/(*$/6(59,&(6

:HUH\RXU5XUDO3URJUDPIXQGVXVHGWRSURYLGHYLFWLPVHUYLFHVDQGRUOHJDOVHUYLFHVWRYLFWLPV
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Check yes if Rural Program-funded staff provided these services or if Rural Program funds were used
to support these services during the current reporting period. Report all victims/survivors served, and
services provided with Rural Program funds, whether by a victim services agency or victim services within
law enforcement, prosecution, or the court system. Report criminal justice activities, such as 911 calls and
investigations, in section E only.
Yes—answer questions 29-44
No—skip to section E

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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 victim/survivor 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, victims/survivors are those against whom the sexual
assault, domestic violence, dating violence, stalking, and/or child sexual abuse was directed. If the
victim/survivor experienced more than one victimization, that person should be counted only once
under the primary victimization. All types of victimizations will be captured in question 30. Child victims
may only be counted if they are victims/survivors of child sexual abuse. Do not report secondary
victims here. Secondary victims will be captured in question 32.)

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OMB Clearance #
Expiration Date:

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(For each victim/survivor reported in 29A and 29B, report the number of victims/survivors who began
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using Rural Program funds to provide victim services, than all victims/survivors in 29A and 29B
should be reported as new. If the victim/survivor has been counted as served or partially served in
a previous reporting period do not include them here, even if the victim/survivor sought services for
a new victimization. For example, if you provided services to a domestic violence victim during the
previous reporting period, and that victim returned during the current reporting period after being
sexually assaulted, you would not report them in this question, and instead would report the additional
victimization in question 31.)
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(For each victim reported as served or partially served in question 29A and 29B, report any additional
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only once under each additional victimization.)
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coercion, or in which the person induced to perform such act has not attained 18 years of age; and/
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through the use of force, fraud, or coercion for the purpose of subjection to involuntary servitude,
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OMB Clearance #
Expiration Date:

32. 1XPEHURIVHFRQGDU\YLFWLPVVHUYHG
Please do not answer this question without referring to the separate instructions for further explanation
and for examples of how and when to report secondary victims.
(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 secondary victim who received services during the
current reporting period should be counted only once and in only one of the listed categories, which
should correspond to the category of victimization of the primary victim. For purposes of this question,
secondary victims are those who are indirectly affected by the domestic violence, dating violence,
sexual assault, and/or stalking—i.e., children, siblings, spouses or intimate partners, grandparents,
other affected relatives, friends, neighbors, etc.)
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(Check all that apply, indicating whether the reason applies to victims/survivors who were partially
served, victims/survivors who were not served, or both.)
3DUWLDOO\
Not
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Hours of operation
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Lack of childcare
Program reached capacity
Program rules not acceptable to victim/survivor
Program unable to provide service due to limited resources/priority-setting
Services inappropriate or inadequate for victims/survivors with mental health
issues
Services inappropriate or inadequate for victims/survivors with substance
abuse issues
Services not appropriate for victim/survivor
Services not available for victims/survivors accompanied by male adolescents
Transportation
Other (specify):

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OMB Clearance #
Expiration Date:

34. 'HPRJUDSKLFVRIYLFWLPVVXUYLYRUVVHUYHGRUSDUWLDOO\VHUYHG
(Based on the primary victims/survivors reported in 29A and 29B, provide the total numbers for all that
apply. Because victims/survivors may identify in more than one category of race/ethnicity, the total for
“Race/ethnicity” may exceed the total number of victims/survivors reported in questions 29A and 29B.
However, the total number of victims/survivors reported under “Race/ethnicity” should not be less than
the total number of victims/survivors reported in questions 29A and 29B. The total number of victims/
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number of victims/survivors reported in questions 29A and 29B. Those victims/survivors for whom
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report demographics for secondary victims.)
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American Indian or Alaska Native
Asian
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Unknown
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0–6
7 – 10
11 – 17
18 – 24
25 – 59
60 +
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727$/$*( (should equal

, the sum 29A and 29B)

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34. 'HPRJUDSKLFVRIYLFWLPVVXUYLYRUVVHUYHGRUSDUWLDOO\VHUYHGFRQW
1XPEHURI
YLFWLPVVXUYLYRUV

2WKHUGHPRJUDSKLFV
Lesbian, gay, bisexual, transgender, or queer (LGBTQ) individuals
People with disabilities
3HRSOHZLWKOLPLWHG(QJOLVKSURÀFLHQF\
People who are D/deaf or hard of hearing
People who are immigrants/refugees/asylum seekers
People who live in rural areas

35. 9LFWLPVVXUYLYRUV·UHODWLRQVKLSWRRIIHQGHUE\YLFWLPL]DWLRQ
(For those victims/survivors reported as served and partially served in 29A and 29B, report the victim/
survivor’s relationship to the offender by type of victimization. If a victim/survivor experienced more
than one type of victimization and/or was victimized by more than one perpetrator, count the victim/
survivor in all categories that apply. The total number of relationships in the sexual assault column
must be at least
; the total number of relationships in the domestic violence/dating violence
column must be at least
; the total in the stalking column must be at least
; and
the total number in the child sexual abuse column must be at least
.)

9LFWLPVVXUYLYRUV·
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1XPEHURIYLFWLPVVXUYLYRUVUHODWLRQVKLSVE\YLFWLPL]DWLRQ
Domestic
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Current or former spouse or intimate
partner
Other family or household member
Acquaintance (neighbor, employee, coworker, student, schoolmate, etc.)
Current or former dating relationship
Stranger
Relationship unknown
727$/

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36a. 9LFWLPVHUYLFHV
(Report the number of victims/survivors from 29A and 29B who received Rural Program-funded
services during the current reporting period. Count each victim/survivor only once for each type of
service they received under the number of victims/survivors served column. Under the number of
times service was provided column, report the total number of times victims/survivors received the
grant-funded service during the current reporting period. The total for each type of service under the
number of victims/survivors column should not be higher than the total of 29A and 29B [
].
Shelter services should be reported in question 36b. Legal assistance provided by a grant-funded
attorney or paralegal should be reported in questions 40-42.)
7\SHRIVHUYLFH

1XPEHURI
YLFWLPVVXUYLYRUV
VHUYHG

Child advocacy (Including guardian ad litem)
Child care
Civil legal advocacy/court accompaniment (Assisting a victim/survivor
with civil legal issues including preparing paperwork for a protection
order and accompanying victim/survivor to a protection order hearing,
administrative hearing, or other civil court proceeding. Does not include
advocacy by attorneys and/or paralegals)
Criminal justice advocacy/court accompaniment (Assisting a victim/
survivor with criminal legal issues including notifying the victim/survivor
of case status, hearing dates, plea agreements, and sentencing terms;
preparing paperwork such as victim impact statements; accompanying
a victim/survivor 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
LGHQWLÀHVDVVHVVHVDQGLQWHUYHQHVZLWKDQLQGLYLGXDOLQFULVLVVRDVWR
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)
Forensic exam (Exams conducted by a sexual assault forensic examiner
or a sexual assault nurse examiner)
Hospital/clinic/other medical response (Accompanying a victim/
survivor to, or meeting a victim/survivor at, the hospital, clinic, or
PHGLFDORIÀFH
Language services (Interpretation, translation, etc.)
Support group/counseling services (Individual or group counseling or
support provided by a volunteer, peer, or professional)
Transportation
Victim/survivor advocacy (Actions designed to help the victim/survivor
obtain needed support, resources, or services including employment,
health care, victim’s compensation, etc.)
Other (specify):

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1XPEHURI
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E6KHOWHUVHUYLFHV
(Report the total number of victims/survivors and accompanying family members, who received
emergency shelter and/or transitional housing provided with Rural Program funds during the current
reporting period. This should be an unduplicated count for both victims/survivors and for family
members. This means that each victim/survivor 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 and/or transitional housing to victims/survivors and family
members. The number of bed nights is computed by multiplying the number of victims/survivors
and family members by the number of nights they stayed in the shelter. The number of bed nights
ZLOOW\SLFDOO\EHVLJQLÀFDQWO\KLJKHUWKDQWKHQXPEHURIYLFWLPVVXUYLYRUVDQGIDPLO\PHPEHUV)RU
example, one victim/survivor 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.)
6KHOWHUVHUYLFH

1XPEHURI
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1XPEHURIIDPLO\
PHPEHUV(include
all children here)

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Emergency shelter
Transitional housing

37. +RWOLQHVXSSRUWLQIRUPDWLRQDQGUHIHUUDO
(Report the number of hotline requests received from primary victims/survivors, and the total number
of hotline requests that were responded to by Rural Program-funded staff or with Rural Program
funds, during the current reporting period. Primary victims/survivors whose requests are reported
here should not be reported as victims/survivors served in question 29 unless they also received at
least one of the services listed in questions 36A Victim Services or 36B Shelter Services. Victims/
survivors who receive services such as crisis intervention or victim advocacy in addition to basic
hotline information and/or referrals, should also be reported in question 36A. Hotline requests that
include victim advocacy or crisis intervention services are those that require more time than average
and involve a more intensive focus on the immediate needs and situation of the victim/survivor. For
examples of when to report only the hotline request and when to report both the hotline request and a
service or services in question 36A, see separate instructions.)
5HTXHVWVIURP
YLFWLPVVXUYLYRUV
Hotline support, information and referral (Support or
information and referral provided over an agency’s hotline,
telephone, or web-based communication)

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7RWDOQXPEHURI
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38. 9LFWLPZLWQHVVQRWLÀFDWLRQRXWUHDFKWRYLFWLPVVXUYLYRUV
(Report the number of unsolicitedOHWWHUVSKRQHFDOOVRUYLVLWVWRYLFWLPVVXUYLYRUVRIVSHFLÀFLQFLGHQWV
RIVH[XDODVVDXOWGRPHVWLFYLROHQFHGDWLQJYLROHQFHVWDONLQJDQGRUFKLOGVH[XDODEXVHLGHQWLÀHG
in police reports or court documents, informing them of services and/or providing information about
WKHFULPLQDOMXVWLFHV\VWHP9LFWLPVVXUYLYRUVZKRDUHWKHUHFLSLHQWVRIWKHVHQRWLÀFDWLRQRXWUHDFK
activities should not be reported as victims/survivors served in question 29 unless they also received
at least one of the services listed in questions 36A Victim Services or 36B Shelter Services. Victims/
survivors who receive services such as criminal justice advocacy in the course of a telephone or
outreach visit should also be reported in question 36A.)
1XPEHURIQRWLÀFDWLRQRXWUHDFK
DFWLYLWLHVWRYLFWLPVVXUYLYRUV
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(unsolicited letters, phone calls, or visits)
39. 3URWHFWLRQRUGHUV
5HSRUWWKHWRWDOQXPEHURIWHPSRUDU\DQGRUÀQDOSURWHFWLRQRUGHUVUHTXHVWHGDQGJUDQWHGfor which
Rural Program-funded victim services staff provided assistance to victims/survivors during the current
reporting period. Protection orders include those ordered on behalf of children. 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. If Rural Program-funded attorneys or paralegals
assisted victims/survivors in obtaining protection orders, those orders should be reported in questions
40-43.)
6H[XDODVVDXOWSURWHFWLRQRUGHUV

Temporary orders

)LQDORUGHUV

Temporary orders

)LQDORUGHUV

Temporary orders

)LQDORUGHUV

Temporary orders

)LQDORUGHUV

Number requested
Number granted
'RPHVWLFYLROHQFHGDWLQJ
YLROHQFHSURWHFWLRQRUGHUV
Number requested
Number granted
6WDONLQJSURWHFWLRQRUGHUV
Number requested
Number granted
&KLOGVH[XDODEXVH
protection orders
Number requested
Number granted

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UHSRUWLQJSHULRG"
Check yes if your Rural Program-funded staff provided these services to victims/survivors, or if Rural
Program funds were used to support these services during the current reporting period.
Yes—answer questions 40-43
No—skip to question 44
$QVZHUTXHVWLRQV40-43RQO\LI\RXU5XUDO3URJUDPIXQGVVXSSRUWHGDQDWWRUQH\DQGRUSDUDOHJDOZKR
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ɶ
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40. /HJDOLVVXHV
(Report the total number of legal issues addressed by Rural Program-funded attorneys or paralegals
during the current reporting period. Count a victim/survivor once in each category of legal issue [A-J]
IRUZKLFKWKH\UHFHLYHGDVVLVWDQFH)RU%)DPLO\ODZPDWWHUVDQG*,PPLJUDWLRQPDWWHUVSURYLGHDQ
unduplicated count of victims/survivors who received assistance in one or more of the subcategories
listed under each of those general categories, and report the number of victims/survivors who received
assistance in each of the subcategories.)
1XPEHURI
/HJDOLVVXHV
YLFWLPVVXUYLYRUV
A. Protection orders WHPSRUDU\DQGÀQDOHQIRUFHPHQWRIH[LVWLQJ32
B. Family law matters (unduplicated count of victims/survivors receiving
assistance in one or more of the subcategories [i-v] below)
i. Divorce
ii. Custody/visitation
iii. Establishment of paternity
iv. Child/spousal support
v. Other family law matters
C. &RQVXPHUÀQDQFH(credit, debt, bankruptcy, tax, etc.)
D. Employment
E. Income maintenance (TANF, disability, food stamps, unemployment)
F. Housing
G. Immigration matters (unduplicated count of victims receiving assistance
in one or more of the subcategories [i-v] below)
i. 9$:$VHOISHWLWLRQ
ii. Cancellation of removal
iii. U visa
iv. T visa
v. Other immigration matters
H. Criminal issues (sexual assault, domestic violence/dating violence,
stalking. Does not include defending victims/survivors accused of
criminal activities.)
I.

Educational issues

J.

Other (specify):

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OMB Clearance #
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41. 1XPEHURIYLFWLPVVXUYLYRUVZKRUHFHLYHGDVVLVWDQFHZLWKOHJDOLVVXHVLQTXHVWLRQ
(Report an unduplicated count of victims/survivors who received assistance with at least one legal
issue in question 40. If they received assistance with more than one legal issue, count them only once
in this question and report them below in question 42.)
Total number of victims/survivors who received assistance with legal issues:
42. 1XPEHURIYLFWLPVVXUYLYRUVZKRUHFHLYHGDVVLVWDQFHZLWKPXOWLSOHOHJDOLVVXHV
(Report the number of victims/survivors who received Rural Program-funded services in more than
one of the categories [A-J] listed in question 40 during the current reporting period. For purposes of
this question, consider all family law matters [section B] as one category and all immigration matters
>VHFWLRQ*@DVRQHFDWHJRU\
Total number of victims/survivors who received assistance with multiple legal issues:

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OMB Clearance #
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43. /HJDORXWFRPHV
(Please report an outcome for all cases closed or issues resolved during the current reporting period
for which services were provided by Rural Program-funded attorneys or paralegals.)
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$GPLQLVWUDBrief
Court
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decision
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decision

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action
action

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Protection orders
(temporary and
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existing PO)
Divorce
Custody/visitation
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paternity
Child/spousal
support
Other family law
matters
&RQVXPHUÀQDQFH
(credit, debt, bankruptcy, tax, etc.)
Employment
Income maintenance
(TANF, disability,
food stamps,
unemployment)
Housing
9$:$VHOISHWLWLRQ
Cancellation of
removal
U Visa
T Visa
Other immigration
matters
Criminal issues
Educational issues
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Other
UHVXOW

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44. 2SWLRQDO$GGLWLRQDOLQIRUPDWLRQ
(Use the space below to discuss the effectiveness of victim services or legal services funded or
supported by your Rural Program grant and to provide any additional information you would like to
share about your victim services activities beyond what you have provided in the data above. An
example might include that your agency, as the result of Rural Program funding, was able to provide
medical accompaniment to an increased percentage of sexual assault victims/survivors, which
resulted in a higher percentage of victims/survivors seeking additional support services.) (Maximum –
2000 characters)

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SECTION

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Expiration Date:

E1

&5,0,1$/-867,&(6<67(0
/DZ(QIRUFHPHQW

:HUH\RXU5XUDO3URJUDPIXQGVXVHGIRUODZHQIRUFHPHQWDFWLYLWLHVGXULQJWKHFXUUHQWUHSRUWLQJSHULRG"
Check yes if your Rural Program grant funded law enforcement activities. If Rural Program funds supported
only a victim assistant/victim-witness specialist or victim advocate located in a law enforcement agency, then
only section D Victim Services should be completed.
Yes—answer questions 45-48
No—skip to E2

ɶ
ɶ

45. $FWLYLWLHV
(Report the number of activities relating to sexual assault, domestic violence, dating violence, stalking,
and/or child sexual abuse cases/incidents for the current reporting period. If an activity relates to a
case/incident involving more than one type of crime, the activity should be counted only once under
the primary victimization.)
$FWLYLW\

6H[XDO
DVVDXOW

Domestic
YLROHQFH
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Calls for assistance (All 911 and other calls made to law
enforcement)
Incident reports (All responses to an incident as reported on
an incident report)
Cases/incidents investigated (All cases in which evidence
was collected/witnesses interviewed relating to an incident)
Forensic medical evidence (All cases in which rape kits were
processed)
Arrests (All arrests made by law enforcement, except dual
arrests)
Dual arrests (Responses by law enforcement in which two
parties involved in the incident are arrested)
Protection/ex parte/temporary restraining orders served
(All instances in which these types of orders were served on
offenders)
Arrests for violation of bail bond (All instances in which
arrests were made of offenders who violated conditions set
out in their bail bonds)
Enforcement of warrants (All instances in which warrants
relating to these incidents were enforced)
Arrests for violation of protection order
Protection orders issued (All orders directly issued by law
enforcement or issued by the court at the direct request of
law enforcement in jurisdictions where law enforcement
RIÀFHUVDUHVRDXWKRUL]HG
Referrals of cases to prosecutor
Referred for federal prosecution
Lethality assessment
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Expiration Date:

46. 9LFWLPVXUYLYRUUHIHUUDOVWRYLFWLPVHUYLFH
(Report the total number victim/survivor referrals to victim services by Rural Program-funded staff
GXULQJWKHFXUUHQWUHSRUWLQJSHULRG´*RYHUQPHQWDOµUHIHUVWRYLFWLPVHUYLFHVSURYLGHGE\YLFWLP
assistants or victim-witness specialists/coordinators employed by criminal justice agencies, such as
law enforcement, prosecution, courts, or probation, that are targeted to victims/survivors of domestic
violence, dating violence, sexual assault, stalking, and/or child sexual abuse. “Non-governmental”
UHIHUVWRVHUYLFHVSURYLGHGE\QRQSURÀWFRPPXQLW\EDVHGDJHQFLHVWRYLFWLPVVXUYLYRUVRIGRPHVWLF
violence, dating violence, sexual assault, stalking, and/or child sexual abuse.)
*RYHUQPHQWDOYLFWLPVHUYLFHV

1RQJRYHUQPHQWDOYLFWLPVHUYLFHV

Number of victim/survivor
referrals

47. 3URWHFWLRQRUGHUV
5HSRUWWKHWRWDOQXPEHURIWHPSRUDU\DQGRUÀQDOSURWHFWLRQRUGHUVUHTXHVWHGDQGJUDQWHGIRUZKLFK
Rural Program-funded law enforcement provided assistance to victims/survivors during the current
reporting period. Protection orders include those ordered on behalf of children. 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.)
6H[XDODVVDXOWSURWHFWLRQRUGHUV

Temporary orders

)LQDORUGHUV

Temporary orders

)LQDORUGHUV

Temporary orders

)LQDORUGHUV

Temporary orders

)LQDORUGHUV

Number requested
Number granted
'RPHVWLFYLROHQFHGDWLQJ
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Number requested
Number granted
6WDONLQJSURWHFWLRQRUGHUV
Number requested
Number granted
&KLOGVH[XDODEXVH
protection orders
Number requested
Number granted

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48. 2SWLRQDO$GGLWLRQDOLQIRUPDWLRQ
(Use the space below to discuss the effectiveness of law enforcement activities funded or supported by
your Rural Program grant and to provide any additional information you would like to share about these
activities beyond what you have provided in the data above. An example might include an increase
in the number of cases accepted for prosecution as the result of a Rural Program-funded specialized
investigator focused on domestic violence, dating violence, sexual assault, stalking, and/or child sexual
abuse.)(Maximum – 2000 characters.)

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E2

3URVHFXWLRQ

:HUH\RXU5XUDO3URJUDPIXQGVXVHGIRUSURVHFXWLRQGXULQJWKHFXUUHQWUHSRUWLQJSHULRG"
Check yes if your Rural Program grant funded prosecution activities during the current reporting period. If
Rural Program funds supported only a victim assistant/victim witness specialist or a victim advocate located
LQDSURVHFXWLRQRIÀFHWKHQRQO\VHFWLRQ'9LFWLP6HUYLFHVVKRXOGEHFRPSOHWHG
Yes—answer questions 49-54
No—skip to E3

ɶ
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49a. 1XPEHURIFDVHVUHFHLYHGDFFHSWHGIRUSURVHFXWLRQGHFOLQHGWUDQVIHUUHGRUUHIHUUHG
(Report the number of domestic violence, dating violence, sexual assault, stalking, and/or child
sexual abuse-related case referrals received--including cases already charged before reaching the
SURVHFXWRU·VRIÀFH2IWKRVHFDVHVUHFHLYHGUHSRUWWKHQXPEHUWKDWZHUHDFFHSWHGDQGWKHQXPEHU
that were declined for prosecution during the current reporting period. A case should be characterized
by the most serious offense and may include numerous charges or counts. In most instances, a case
will refer to one victim, one offender, and one incident. It is strongly suggested that you refer to the
separate instructions for examples of how to count and characterize cases.)
Misdemeanor and felony domestic violence cases may include any assaults, battery, vandalism, or
other offenses that occurred in a domestic violence incident. Your state law or tribal code does not
have to name an offense ‘‘domestic violence’ for a case addressing that offense to be counted here.
Similarly, cases addressing sexual assault, stalking and child sexual abuse offenses should be counted,
even if your state law or tribal code uses other names for these types of offenses, such as ‘‘sexual
battery’’ or ‘‘harassment.’’
5HFHLYHGDFFHSWHGGHFOLQHG
transferred

Domestic
YLROHQFHGDWLQJ
YLROHQFH

6H[XDO
DVVDXOW

6WDONLQJ

a. Number of cases received
b. Number of cases accepted for
prosecution
c. Number of cases declined
d. Transferred to higher or lower
court that is outside grant-funded
jurisdiction
e. Referred for federal prosecution
HJÀUHDUPVFKDUJHVLQWHUVWDWH
protection orders)

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&KLOGVH[XDO
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OMB Clearance #
Expiration Date:

E5HDVRQVIRUGHFOLQLQJFDVHV
(Of those cases reported in line c of question 49A as declined, report only the primary reason for
the decision to decline prosecution. Please see separate instructions for further explanation of the
reasons and for examples of how to apply them.)
5HDVRQIRUGHFOLQLQJ

Domestic
YLROHQFHGDWLQJ
YLROHQFH

6H[XDO
DVVDXOW

6WDONLQJ

&KLOGVH[XDO
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,QVXIÀFLHQWHYLGHQFH(returned for
further investigation)
,QVXIÀFLHQWHYLGHQFHYLFWLP
unavailable (no further action
requested)
Request of victim/victim safety
Other (specify):
49c. 7ULEDOJUDQWHHV
(Report the total number of sexual assault, domestic violence, dating violence, stalking, and child
sexual abuse cases referred for state or federal prosecution during the current reporting period.)
Domestic
YLROHQFHGDWLQJ 6H[XDODVVDXOW
YLROHQFH

6WDONLQJ

Cases referred to federal entity for
prosecution
Cases referred to state entity for
prosecution
727$/

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50. Disposition of cases
(Report the dispositions of all cases resolved during the current reporting period. Please refer to the
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acquitted.)
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FDWHJRU\

Type of case

3OHDGWROHVVHU
FKDUJHLQVDPH
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1XPEHURI
1XPEHU
deferred
disadjudicamissed
tions

3OHDGDVFKDUJHG

1XPEHUFRQYLFWHG

Domestic violence/
dating violence
ordinance
Misdemeanor
domestic violence/
dating violence
Felony domestic
violence/dating
violence
Domestic violence/
dating violence
homicide
Misdemeanor
sexual assault
Felony sexual
assault
Stalking ordinance
Misdemeanor
stalking
Felony stalking
Misdemeanor child
sexual abuse
Felony child sexual
abuse
Violation of
protection order
Violation of bail
Violation of
probation or parole
Violation of other
court order
Other (specify):

727$/

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1XPEHU
727$/
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OMB Clearance #
Expiration Date:

51. Other issues present in cases that reached disposition
(If possible, use the space below to discuss the extent to which cases that were characterized as
domestic violence, dating violence, sexual assault, stalking, and/or child sexual abuse also included
additional charges or elements of domestic violence, dating violence, sexual assault, stalking, and/
or child sexual abuse. For example, cases reported above as domestic violence/dating violence felony
cases may also have included counts of misdemeanor sexual assault, and cases reported as felony
sexual assault may also have included stalking charges. The purpose of this question is to gather
information on how often multiple crimes were present in the cases reported. If detailed information is
not available, feel free to provide estimates based on your experience.) (Maximum – 2000 characters)

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(Report the total number of victim/survivor referrals to victim services by Rural Program-funded
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assistants or victim-witness specialists/coordinators employed by criminal justice agencies, such as
law enforcement, prosecution, courts, or probation, that are targeted to victims/survivors of domestic
violence, dating violence, sexual assault, stalking, and/or child sexual abuse. “Non-governmental”
UHIHUVWRVHUYLFHVSURYLGHGE\QRQSURÀWFRPPXQLW\EDVHGDJHQFLHVWRYLFWLPVVXUYLYRUVRIGRPHVWLF
violence, dating violence, sexual assault, stalking, and/or child sexual abuse.)
*RYHUQPHQWDOYLFWLPVHUYLFHV

1RQJRYHUQPHQWDOYLFWLPVHUYLFHV

Number of victim/survivor
referrals

53. 3URWHFWLRQRUGHUV
5HSRUWWKHWRWDOQXPEHURIWHPSRUDU\DQGRUÀQDOSURWHFWLRQRUGHUVUHTXHVWHGDQGJUDQWHGIRU
which Rural Program-funded prosecutors provided assistance to victims/survivors during the current
reporting period. Protection orders include those ordered on behalf of children. 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.)
6H[XDODVVDXOWSURWHFWLRQRUGHUV

Temporary orders

)LQDORUGHUV

Temporary orders

)LQDORUGHUV

Temporary orders

)LQDORUGHUV

Temporary orders

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Number requested
Number granted
'RPHVWLFYLROHQFHGDWLQJ
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Number requested
Number granted
6WDONLQJSURWHFWLRQRUGHUV
Number requested
Number granted
&KLOGVH[XDODEXVH
protection orders
Number requested
Number granted

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54. 2SWLRQDO$GGLWLRQDOLQIRUPDWLRQ
(Use the space below to discuss the effectiveness of prosecution activities funded or supported by
your Rural Program grant and to provide any additional information you would like to share about
these activities beyond what you have provided in the data above. An example might include expedited
prosecution of felony domestic violence/dating violence and sexual assault cases as the result of
funding a specialized prosecutor to handle those cases. You may also use the space to explain high
numbers of cases declined or dismissed or the impact of a “no-drop” policy on conviction rates.)
(Maximum – 2000 characters)

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Courts

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Check yes if your Rural Program grant funded court activities. If Rural Program funds supported only a victim
advocate located in a court, then only section D Victim Services should be completed.
Yes—answer questions 55-61
No—skip to E4

ɶ
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55. 'LVSRVLWLRQRIFULPLQDOFDVHV
(Report the dispositions of sexual assault, domestic violence, dating violence, stalking, and/or child
sexual abuse-related cases resolved during the current reporting period.)
Misdemeanor and felony domestic violence cases may include any assaults, battery, vandalism, or
other offenses that occurred in a domestic violence incident. Your state law or tribal code does not
have to name the offense “domestic violence” to be counted here. Similarly, sexual assault, stalking,
and child sexual abuse cases should be counted under the appropriate sexual assault, stalking, or child
sexual abuse offense listed below (e.g., felony sexual assault), even if your state law or tribal code uses
another name for these types of offenses, such as “sexual battery” or “harassment.”

Type of case

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dismissed

1XPEHURI
deferred
adjudications

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Domestic violence/dating violence ordinance
Misdemeanor domestic violence/dating violence
Felony domestic violence/dating violence
Domestic violence/dating violence homicide
Misdemeanor sexual assault
Felony sexual assault
Stalking ordinance
Misdemeanor stalking
Felony stalking
Misdemeanor child sexual abuse
Felony child sexual abuse
Violation of protection order
Violation of bail
Violation of probation or parole
Violation of other court order
727$/

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56. -XGLFLDOPRQLWRULQJ
(Report the number of sexual assault, domestic violence, dating violence, stalking, and/or child sexual
abuse cases reviewed by the court for compliance with conditions of probation or other court-ordered
conditions, or for violations of those conditions. Also report the total number of individual review
hearings conducted. Include family and juvenile courts. The number of review hearings is the number
of individual hearings held for each offender, even when that offender is reviewed during the same
monitoring sessions as other offenders. For example, if 10 offenders were reviewed at the same three
sessions during the reporting period, the number of offenders reviewed would be 10 and the number
of hearings conducted would be 10 multiplied by 3, or 30.)
1XPEHURIRIIHQGHUVUHYLHZHG

1XPEHURILQGLYLGXDOUHYLHZ
KHDULQJVFRQGXFWHG

Sexual assault
Domestic violence/dating violence
Stalking
Child sexual abuse

57. 'LVSRVLWLRQVRIYLRODWLRQV
(Report the number of sexual assault, domestic violence, dating violence, stalking, and/or child sexual
abuse cases in which there were dispositions of violations during the current reporting period. The
violation does not have to have occurred during this reporting period, only the disposition. A case may
be counted more than once if there were multiple violations.)
9LRODWLRQ

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Conditions
added

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New criminal behavior
Failure to attend mandated
batterer intervention program
(BIP)
Failure to attend mandated
offender treatment (does not
include BIP)
Other condition of probation,
parole, or other conditional
release
727$/

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(Report the total number of victim/survivor referrals to victim services by Rural Program-funded staff
GXULQJWKHFXUUHQWUHSRUWLQJSHULRG´*RYHUQPHQWDOµUHIHUVWRYLFWLPVHUYLFHVSURYLGHGE\YLFWLP
assistants or victim-witness specialists/coordinators employed by criminal justice agencies, such as
law enforcement, prosecution, courts, or probation that are targeted to victims/survivors of domestic
violence, dating violence, sexual assault, stalking, and/or child sexual abuse. “Non-governmental”
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survivors of domestic violence, dating violence, sexual assault, stalking, and/or child sexual abuse.)
*RYHUQPHQWDOYLFWLPVHUYLFHV

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Number of victim/survivor
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59. &LYLOSURWHFWLRQRUGHUV
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court during the current reporting period. Civil protection orders include those ordered on behalf of
children. These orders may also be referred to as protection from abuse, protection from harassment,
anti-harassment, or restraining orders.)
6H[XDODVVDXOWSURWHFWLRQRUGHUV

Temporary orders

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Temporary orders

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Temporary orders

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Temporary orders

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Number requested
Number granted
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Number requested
Number granted
6WDONLQJSURWHFWLRQRUGHUV
Number requested
Number granted
&KLOGVH[XDODEXVH
protection orders
Number requested
Number granted
60. &ULPLQDOSURWHFWLRQRUGHUV
(Report the total number of criminal protection orders requested and the total number granted by the
court to victims/survivors of domestic violence, dating violence, sexual assault, stalking, and/or child
sexual abuse during the current reporting period. These orders may be referred to as no-contact or
stay-away orders.)
5HTXHVWHG

Granted

Number of protection orders

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61. 2SWLRQDO$GGLWLRQDOLQIRUPDWLRQ
(Use the space below to discuss the effectiveness of court activities funded or supported by your Rural
Program grant and to provide any additional information you would like to share about those activities
beyond what you have provided in the data above. An example might include an increased percentage
of court-monitored offenders complying with mandated offender treatment and batterer intervention
programs.) (Maximum – 2000 characters)

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Check yes if your Rural Program grant funded probation and parole activities.
Yes—answer questions 62-66
No—skip to E5

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62. 1XPEHURIRIIHQGHUV
(Report the total number of sexual assault, domestic violence/dating violence, stalking, and/or child
sexual abuse offenders monitored by Rural Program-funded staff during the current reporting period
under the “Number of offenders” column. This is an unduplicated count. Report the number of
offenders who completed supervision without any violations. Also, report the number of offenders who
completed supervision with at least one violation during the time they were under supervision. )
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offenders

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offenders
Sexual assault offenders
Child sexual abuse offenders
Stalking offenders
Dual offenders (domestic violence/dating
violence and sexual assault/child sexual
abuse offenders)
727$/
63. 0RQLWRULQJDFWLYLWLHV
(For offenders reported in question 62, report the number of monitoring activities engaged in during
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to-face contact with 100 of those offenders during the reporting period. Multiplying those offenders by
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900. The number of offenders reported as having face-to-face meetings would be 100 and the number
of total face-to-face contacts would be 900.)
$FWLYLW\

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Face-to-face meeting with offender
Telephone contact with offender
Unscheduled surveillance of offender
Electronic monitoring *36UDGLRIUHTXHQF\
$FWLYLW\
Outreach to victims/survivors
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64. 'LVSRVLWLRQVRIYLRODWLRQV
(Report the total number of sexual assault, domestic violence, dating violence, stalking, and/or child
sexual abuse cases in which there were dispositions of violations during the current reporting period.
The violation does not have to have occurred during this reporting period, only the disposition. A case
may be counted more than once if there were multiple violations.)
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New criminal behavior
Failure to attend mandated
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(BIP)
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include BIP)
Other condition of probation,
parole, or other conditional
release
727$/

65. 9LFWLPVXUYLYRUUHIHUUDOVWRYLFWLPVHUYLFHV
(Report the total number of victim/survivor referrals to victim services by Rural Program-funded staff
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assistants or victim-witness specialists/coordinators employed by criminal justice agencies, such as
law enforcement, prosecution, courts, or probation, that are targeted to victims/survivors of domestic
violence, dating violence, sexual assault, stalking, and/or child sexual abuse. “Non-governmental”
UHIHUVWRYLFWLPVHUYLFHVSURYLGHGE\QRQSURÀWFRPPXQLW\EDVHGDJHQFLHVWKDWDUHWDUJHWHGWRYLFWLPV
survivors of domestic violence, dating violence, sexual assault, stalking, and/or child sexual abuse.)
*RYHUQPHQWDOYLFWLPVHUYLFHV

1RQJRYHUQPHQWDOYLFWLPVHUYLFHV

Number of victim/survivor
referrals

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(Use the space below to discuss the effectiveness of court activities funded or supported by your Rural
Program grant and to provide any additional information you would like to share about those activities
beyond what you have provided in the data above. An example might include an increased percentage
of court-monitored offenders complying with mandated offender treatment and batterer intervention
programs.) (Maximum – 2000 characters)

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Check yes if Rural Program-funded staff or Rural Program funds directly supported BIP activities.
Yes--answer questions 67-69, providing information for Rural Program-funded activities
No—skip to section F

ɶ
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67. 2IIHQGHUVLQSURJUDP
(Report the number of offenders in your batterer intervention program (BIP) during the current
reporting period.)
Number of offenders in BIP program:

68. Outcomes
(Report the number of domestic violence and dating violence offenders in your program who completed
the program, who were terminated from the program, or who returned to the program after termination
during the current reporting period.)
1XPEHURIRIIHQGHUV
Completed program
Terminated from program
Returned to program after termination
Other (specify):

69. /HQJWKRI%,3LQZHHNV
(Report the number of weeks that batterers are expected to remain in the program in order to complete
it. If your BIP has more than one program length and/or curriculum, provide the length for each type of
program.)
$

B

Number of weeks

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SHULRGDVWKH\ZHUHLGHQWLÀHGLQ\RXUJUDQWSURSRVDORUDVWKH\KDYHEHHQDGGHGRUUHYLVHG,QGLFDWH
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 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
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(Consider geographic regions, underserved populations, service delivery systems, types of victims/
survivors, and/or challenges and barriers unique to your state or service area.)
72. :KDWKDV5XUDO3URJUDPIXQGLQJDOORZHG\RXWRGRWKDW\RXFRXOGQRWGRSULRUWRUHFHLYLQJWKLV
IXQGLQJ"
(For example, the money allowed us to expand our service areas and expand services offered to
victims/survivors.)
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(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 Rural 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 victims/survivors, promising practices, positive
or negative unintended consequences. Refer to separate instructions for a fuller explanation and
examples..)
74. 3URYLGHDQ\DGGLWLRQDOLQIRUPDWLRQWKDW\RXZRXOGOLNHXVWRNQRZDERXWWKHGDWDVXEPLWWHG
(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; if your
5XUDO3URJUDPIXQGVVXSSRUWHGVWDII³HJYLFWLPDGYRFDWHVODZHQIRUFHPHQWRIÀFHUVHWF³EXWGLGQRW
report any corresponding victim services or law enforcement activities, you may explain why; if you did
not use program funds to support either staff or activities during the reporting period, please explain
how program funds were used, or not, if you have not already done so; or you might explain that though
you were able to report all protection orders requested for which you provided assistance, you were not
able to report accurately on how many of those were granted.)
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Report on the status of your Rural Program grant goals and objectives as of the end of the current reporting
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victims/survivors of sexual assault, domestic violence, dating violence, stalking, and child sexual abuse,
increasing victim/survivor safety, and enhancing community response (including offender accountability for
both batterers and sex offenders) - Question #71

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victims/survivors of sexual assault, domestic violence, dating violence, stalking, and child sexual abuse,
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Question #72

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Expiration Date:

Provide any additional information that you would like us to know about the data submitted. - Question #74

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OMB Clearance #
Expiration Date:

Provide any additional information that you would like us to know about the data submitted. - Question #74
(cont.)

5XUDO3URJUDP6HPLDQQXDO3URJUHVV5HSRUW‡‡2IÀFHRQ9LROHQFH$JDLQVW:RPHQ

OMB Clearance #
Expiration Date:

Validate

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