THIS IS A SAMPLE GMS FORM. DO NOT USE THIS FORM TO SUBMIT YOUR FINAL DATA TO OVW.
OMB Clearance #1122-0010
SEMI-ANNUAL PROGRESS REPORT FOR
Grants
to
State
Sexual
Assault
and
Domestic
Violence
Coalitions
Program
Brief Instructions: This form must be completed for each Grants to State Sexual Assault and Domestic Violence Coali- tions Program (State Coalitions Program) grant received. The grant administrator or coordinator must ensure that the form is completed fully with regard to all grant activities.
All grantees should read through each section to determine which questions they must answer based on the activities engaged in under this grant during the current reporting period. Sections B and D of this form must be completed by all grantees. In section A, subsection A1 must be answered by all grantees. In subsection A2 and section C, grantees must answer an initial question in each subsection about whether they engaged in certain activities during the current reporting period. If the response is yes, then the grantee must complete that subsection. If the response is no, the rest of that subsection is skipped.
For example, (1) if you only provided training and technical assistance with staff funded under this grant during the current reporting period, you would complete sections A, B, C1, C5, and D (and answer ‘no’ in C2-C4 and C6-C8); or, (2) if you provided training and technical assistance with staff funded under this grant and grant-funded staff developed products during the current reporting period, you would complete sections A, B, C1, C3, C5, and D (and
answer ‘no’ in C2, C4, C6-C8).
The activities of volunteers or interns should be reported if they were coordinated or supervised by State Coalitions Program-funded staff or if State Coalitions Program funds substantially supported their activities.
For further information on filling out this form, refer to the separate set of instructions, which contains detailed definitions and examples illustrating how questions should be answered.
SECTION Page
Number
Section A: |
General Information |
|
1 |
A1: |
Grant Information |
|
1 |
A2: |
Staff Information |
|
2 |
Section B: |
Program Activities |
|
3 |
Section C: |
Function Areas |
|
4 |
C1: |
Training |
|
4 |
C2: |
System Advocacy |
|
8 |
C3: |
Products |
|
11 |
C4: |
Public Awareness |
|
12 |
C5: |
Technical Assistance |
|
14 |
C6: |
Standards of Service |
|
17 |
C7: |
Underserved Populations |
|
18 |
C8: |
Organizational Development and Capacity Building |
|
20 |
Section D: |
Narrative |
|
21 |
State Coalitions Program Semi-annual Progress Report • Office on Violence Against Women
SECTION
A1
Grant Information
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✔ January 1-June 30
✔ July 1-December 31 (Year)
OMB Clearance 121-0280 Expiration Date: 07/31/04
3. Grantee
name
4. Grant
number
(the
federal
grant
number
assigned
to
your
State
Coalitions
Program
grant)
5. Type
of
grantee
organization
(Check
one.)
Dual
Sexual
Assault/Domestic
Violence
Coalition
Sexual
Assault
Coalition
Domestic Violence Coalition
6. Point
of
contact
(person
responsible
for
the
day-to-day
coordination
of
the
grant)
First Name MI Last Name
Agency/organization
name
Address
City State Zip Code Telephone Facsimile
7. What
percentage
of
your
total
operating
budget
is
funded
by
the
State
Coalitions
Program
grant?
(Do not include pass-through funding that the coalition awards to local sexual assault or domestic violence pro-
grams.)
8. Coalition
members
(Report
the
total
number
of
organizational
members,
including
sexual
assault
programs,
domestic
violence
programs,
other
victim
services
agencies,
and
other
organizational
members,
as
applicable
to
your
state
coalition.
Report
the
total
number
of
individual
members,
if
applicable
to
your
state
coalition.
Indi-
vidual
members
are
individual
persons,
not
programs.)
Organizational
members Number
Sexual assault programs/rape crisis centers Domestic violence programs
Sexual assault and domestic violence dual programs Tribal victim services agencies
Other victim service providers Other organizational members
Total number of organizational members 0
Total number of individual members
State Coalitions Program Semi-annual Progress Report • 1 • Office on Violence Against Women
SECTION
Check yes if State Coalitions Program funds were used to pay staff, including part-time staff and contractors.
Yes—answer
question
9
No—skip
to
Section
B
9. Staff
(Report
the
total
number
of
full-time
equivalent
(FTE)
staff
funded
by
the
State
Coalitions
Program
grant
during
the
current
reporting
period.
Report
staff
by
the
function(s)
performed,
not
by
title
or
location.
Include
employees
who
are
part-time
and/or
partially
funded
with
these
grant
funds
as
well
as
consultants/contractors.
Report
grant-funded
overtime.
If
an
employee
or
contractor
was
employed
or
utilized
for
only
a
portion
of
the
reporting
period,
prorate
appropriately.
For
example,
if
you
hired
a
full-time
administrator
in
October
who
was
100%
funded
with
State
Coalitions
Program
funds,
you
would
report
that
as
.5
FTE.
Report
all
FTEs
in
decimals,
not
percentages.
One
FTE
is
equal to
1,040
hours—40
hours
per
week
x
26
weeks.
See
separate
instructions
for
examples
of
how
to calculate
FTEs
for
part-time
staff
and
contractors.)
Staff FTE(s)
Administrator (fiscal manager, executive director)
Attorney
Communications specialist (public awareness, media relations)
Information technology staff Paralegal
Program coordinator (training coordinator, outreach coordinator)
Support staff (secretary, administrative assistant, accountant, bookkeeper)
Systems advocate
Technical assistance provider Trainer
Translator/interpreter Other (specify):
TOTAL
0.00
OMB Clearance # 1121-0280 Expiration Date: 07/31/2004
State Coalitions Program Semi-annual Progress Report • 2 • Office on Violence Against Women
SECTION
B
Program activities (Check all program activities your State Coalition engaged in during the current reporting period. Check the appropriate box to indicate whether the activity was supported with State Coalitions Program funds or another funding source.)
State
Coalitions
Program
funded
source Program activities
Other funding
Providing technical assistance to member programs.Expanding the technological capacity of coalitions and/or member programs.
Developing or enhancing appropriate standards of services for member programs, including culturally appropriate services to underserved populations.
Conducting statewide, regional and/or community-based meetings or workshops for victim advocates, survivors, legal service providers, and criminal justice representatives.
Bringing local programs together to identify gaps in services and to coordinate activities.
Increasing the representation of underserved populations in coordination activities, including providing financial assistance to organizations that serve underserved communities to participate in planning meetings, task forces, committees, etc.
Engaging in activities that promote coalition building at the local and/or state level.
Coordinating federal, state and/or local law enforcement agencies to develop or enhance strategies to address identified problems.
Other
activities
(List
all
other
activities,
not
included
in
question
10,
that
your
State
Coalition
Program
grant
engaged
in
during
the
current
reporting
period.
Check
the
appropriate
box
to
indicate whether
the
activity
was
supported
with
State
Coalitions
Program
funds
or
another
funding
source.)
OMB Clearance # 1121-0280 Expiration Date: 07/31/2004
Other funding
source Activity
a.
b.
c.
d.
e.
f.
SECTION
C1
Training
Check yes if State Coalitions Program-funded staff provided training or if State Coalitions Program funds were used to directly support the training.
Yes—answer
questions
12-15
No—skip
to
C2
For purposes of this reporting form, training means providing information on sexual assault, dating violence, domestic violence, and stalking that enables professionals to improve their response to victims/survivors as it re- lates to their role in the system. Education means providing general information that will increase public aware- ness of sexual assault, dating violence, domestic violence, or stalking. In this subsection, report information on training activities. Educational activities should be reported in subsection C4 Public Awareness.
12.
Type
and
number
of
training
events
provided
(Report
the
number
of
statewide,
regional,
and
community-
based
training
events
by
the
type
of
training
that
were
either
provided
by
State
Coalitions
Program-grant
funded
staff
or
directly
supported
with
State
Coalitions
Program
funds.
Staff
development
training
provided
to State
Co-
alitions
Program-funded
staff
should
not
be
counted.
Use
the
SA/DV
columns
if
training
events
focused
on
both
sexual
assault
and
domestic
violence.)
Type
of
training Total
number
of
training
events
Statewide Regional Community-based
Computer-based training Conferences Teleconferences Videoconferences Workshops/seminars Other (specify):
Sexual assault
Domestic violence/ dating violence
SA/ DV
Sexual assault
Domestic violence/ dating violence
SA/ DV
Sexual assault
Domestic violence/ dating violence
SA/ DV
OMB Clearance121-0 Expiration Date: 07/31/2004
State Coalitions Program Semi-annual Progress Report • 4 • Office on Violence Against Women
13. Number of people trained (Report the number of people trained during the current reporting period by State Coalitions Program-funded staff or training supported by State Coalitions Program funds. Use the category that is most descriptive of the people attending the training event. If you do not know how many people to report in spe- cific categories, you may report the overall number in “Multidisciplinary.” Please use only as a last resort. State Coalitions Program-funded staff attending training should not be counted. Total person-hours are calculated by multiplying the number of people trained by the length of the individual training event.)
Advocacy organization staff (NAACP, AARP) Attorneys/law students (does not include prosecutors) Batterer intervention program staff
Child welfare workers/children’s advocates
Corrections personnel (probation, parole, and correctional facilities staff)
Court personnel (judges, clerks) Educators (teachers, administrators, etc.) Faith-based organization staff
Government agency staff (vocational rehabilitation, food stamps, TANF)
Immigration organization staff Law enforcement officers
Legal services staff (does not include attorneys)
Multidisciplinary (various disciplines at same training)
Sex offender treatment program staff
Sexual assault forensic examiners/sexual assault nurse examiners
Social
service
organization
staff
(non-governmental
–
food
bank,
homeless
shelter)
Substance abuse treatment provider |
|
|
|
|
|
|
Translators/interpreters |
|
|
|
|
||
Tribal government/tribal government agency staff |
|
|
|
|
|
|
OMB Clearance # 11210 Expiration Date : 07/31/2004
Victim assistants (governmental, includes victim-witness specialist/ coordinator)
Volunteers Other (specify): TOTAL
0 0.00
OMB Clearance # 1121-0280 Expiration Date: 07/31/2004
14.
Training
content
areas
(Indicate
all
topics
addressed
in
training
events
provided
with
your
State
Coalitions
Pro-
gram
funds
during
the
current
reporting
period.
Check
all
that
apply.)
Sexual assault, domestic violence, dating violence, and stalking
Advocate
response
Child
witnesses
Confidentiality
Cyberstalking
Dating
violence
overview,
dynamics,
and
services
Domestic
violence
overview,
dynamics,
and
services
Drug
facilitated
sexual
assault
Forensic evidence collection and documentation Mandatory reporting requirements
Response
to
victims/survivors
who
are
incarcerated
Response
to
victims/survivors
who
have
been
trafficked
Safety
planning
for
victims/survivors
Sexual
assault
overview,
dynamics,
and
services
Stalking
overview,
dynamics,
and
services
Supervised
visitation
and
exchange
Other (specify):
Justice system
Civil
court
procedures
Criminal
court
procedures
Decreasing dual arrests/identifying predominant aggressor
Domestic
violence
statues/codes
Firearms
and
domestic
violence
Immigration
Judicial response
Law
enforcement
response
Pro-arrest
policies
Probation
response
Prosecution
response
Protection
orders
(including
full
faith
and
credit)
Sexual
assault
forensic
examinations
Sexual
assault
statutes/codes
Stalking
statutes/codes
Tribal
jurisdiction
and
Public
Law
280
Other
(specify):
Underserved populations
Issues specific to victims/survivors who:
live
in
rural
areas
are
American
Indian
or
Alaska
Native
are
Asian
are
black
or
African
American
are
elderly
are
Hispanic
or
Latino
are
homeless
or
living
in
poverty
are
immigrants,
refugees,
or
asylum
seekers
are
lesbian,
gay,
bisexual,
transgender,
or
intersex
are
Native
Hawaiian
or
other
Pacific
Islander
have
disabilities
have
limited
English
proficiency
have
mental
health
issues
have
substance
abuse
issues
Other
(specify):
Organizational
community
response
Board
roles
and
fiduciary
responsibilies
Collaboration
Coordinated
community
response
Community
response
to
sexual
assault
Discrimination
and
oppression
issues
Emergency
preparedness
Evaluation
Outreach
to
diverse/underserved
populations
Program
accessibility
Program rules
Response
teams
(DART,
DVRT,
SART)
Safety
planning
Standards
of
service
Strategic
planning
Technology
Technology safety issues
Victim
service
administration
and
operations
Other
(specify):
State Coalitions Program Semi-annual Progress Report • 6 • Office on Violence Against Women
OMB Clearance #1122-0010 Expiration Date: 06/30/2011
15.
(Optional)
Additional
information
(Use
the
space
below
to
discuss
the
effectiveness
of
training
activities
funded
or
supported
by
your
State
Coalitions
Program
grant
and
to
provide
any
additional
information
you
would
like
to
share
about
training
activities
beyond
what
you
have
provided
in
the
data
above.
An
example
might
in-
clude
a
change
in how
area
hospitals respond
to
victims
of
domestic
violence,
dating
violence,
sexual
assault,
and
stalking
after
a
state-wide
training
for
hospital
staff.)
(Maximum
-
2000
characters)
SECTION
OMB Clearance #1122-0010 Expiration Date: 06/30/2011
OMB Clearance # 1121-0280 Expiration Da te: 07/31/2004
Yes—answer
questions
16-19
No—skip
to
C3
16.
System
advocacy
activities
(Indicate
the
system
advocacy
activities
convened
or
participated
in
with
State
Co-
alitions
Program
funds
during
the
current
reporting
period.
Check
all
that
apply.)
Systems
advocacy Sexual
assault Domestic
violence/
dating
violence
Appointed, state-level commissions
Community, regional, statewide task force/caucus Multidisciplinary working groups
Project-specific interagency working groups Tribal systems advocacy
Other (specify):
State Coalitions Program Semi-annual Progress Report • 8 • Office on Violence Against Women
17.
Improved
system
response
(Report
the
total
number
of
statewide,
regional,
and
local
meetings
convened
and/
or
attended
by
State
Coalitions
Program-funded
staff
during
the
current
reporting
period.)
Agency/organization Number of meetings convened
Domestic
Number of meetings attended
Domestic
OMB Clearance # 1121-0280 Expiration Date: 07/31/2004
Advocacy organization (NAACP, AARP)
Batterer intervention program Child welfare
Corrections (probation, parole, correctional facility)
Court (state or local)
Dual sexual assault and domestic violence program
Educational institution/organization Faith-based organization
Federal criminal justice
Other federal entities/officials
Government agency (Social Security, TANF)
Health/mental health organization Law enforcement (state or local)
Legal services organization (legal services, bar association, law school)
Prosecutor’s office (state or local)
Sexual assault forensic examiners/sexual as- sault nurse examiners program (SAFE/SANE)
Sexual assault program
Social services organization (non-governmen- tal - food bank, homeless shelter)
Tribal government/tribal government agency University/school
Victims/survivors Other (specify):
Sexual assault
violence/ dating violence
Sexual assault
violence/ dating
violence
18.
Coordination
activities
(Indicate
methods
used
during
the
current
reporting
period
to
coordinate
state
victim
services
activities
and/or
to
collaborate
and
coordinate
with
federal,
state,
and
local
entities
engaged
in
activities
to
reduce
or
end
violence
against women.
Check
all
that
apply.)
Email
E-mail
listserv
Facsimile
Newsletters
Telephone/conference
call
Toll-free
telephone
number
Tracking availability of victim services
U.S.
mail
Webinar
Web
site
Other
(specify):
OMB Clearance # 1121-0280 Expiration Date: 07/31/2004
19.
(Optional)
Additional
information
(Use
the
space
below
to discuss
the
effectiveness
of
system
advocacy
activities
funded
or
supported
by
your
State
Coalitions
Program
grant
and
to
provide
any
additional
information
you
would
like
to
share
about
your
system
advocacy
activities
beyond
what
you
have
provided in
the
data
above.
An
example
might
include:
We
convened a
multi-disciplinary
task
force
of
domestic
violence
programs,
sexual
assault
programs,
and
tribal
government
agencies
which
met
for
one
in-person
and
3
follow-up
phone
sessions
to
develop
policies
and
procedures
for
more
effectively
serving
tribal
populations
in
our
state
resulting
in
an
on-
going
collaboration
with
tribal
leaders
and
a
new
level of
trust.)
(Maximum
-
2000
characters)
State Coalitions Program Semi-annual Progress Report • 10 • Office on Violence Against Women
SECTION
Were your State Coalitions Program funds used to develop, substantially revise, or distribute products
during the current reporting period? Check yes if State Coalitions Program-funded staff developed products or if State Coalitions Program funds directly supported the development, revision, or distribution of products.
Yes—answer
question
20
No—skip
to
C4
20.
Use
of
State
Coalitions
Program
funds
for
product
development,
substantial
revision,
or
distribution
(Report
the
number
of
products
developed,
substantially
revised,
or
distributed
with
State
Coalitions
Program
grant
funds
during
the
current
reporting
period.
Report
the
number
of
new
products
developed
or
substantially
revised
during
the
current
reporting
period;
the
title/topic
and
intended
audience
for
each
product
developed,
re-
vised,
or
distributed;
and
the
number
of
products
used
or
distributed.
If
a
product
was
created
in
or
translated
into
a
language
other
than
English,
including
Braille,
indicate
the
language.
Report
on
products
that
were
newly
de-
veloped
or
substantially
revised
during
the
current
reporting
period,
whether
or
not
they
were
used
or
distributed,
and
on
products
that
were
previously
developed
or
revised
but
were
used
or
distributed
during
the
current
report-
ing
period.
Do
not
report
the
number
of
products
printed
or
copied;
only
report
the
number
developed
or
revised—
in
most
cases
that
number
will
be
one
for
each
product
described
—and/or
the
number
used
or
distributed.
See
separate
instructions
for
examples
of
how
to
report
under
“developed
or
revised”
and
“used
or
distributed.”)
Products
Number developed or revised
Intended
Title/topic audience
Number used or distributed
Other languages
OMB Clearance # 1121-0280 Expiration Date: 07/31/2004
Brochures
Manuals
Newsletter
Training curricula
Training materials
Reports
Fact sheets Web site
(report number of
page views in the used or distributed colulmn)
Videos
Other (specify):
OMClearance # 111-0280 Expiration Date: 07/31/2004
SECTION
reporting period? Check yes if State Coalitions Program-funded staff were used to support public awareness activities or if State Coalitions Program funds were used to directly support public awareness activities.
Yes—answer
questions
21-22
No—skip
to
C5
21.
Public
awareness
activities
(Indicate
the
activities
that
were
supported
with
State
Coalitions
Program
funds
during
the
current
reporting
period.
Indicate
by
checking
the
appropriate
box[es]
whether
the
focus
of
the
activity
was
sexual
assault,
domestic
violence,
dating
violence,
stalking,
or
a
combination
of
those
issues.
Check
all
that
apply.)
Activities Sexual assault Domestic violence/ Stalking dating violence
Community
organizing/community
events
(rallies,
speak
outs,
Take
Back the
Night,
vigils)
Educational exhibits (Clothesline Project, silent witness, information tables)
Media
campaigns
(press
conferences,
public
ser-
vice
announcements,
articles)
Productions for public awareness (video series, theater productions)
Other (specify):
State Coalitions Program Semi-annual Progress Report • 12 • Office on Violence Against Women
OMB Clearance #1122-0010 Expiration Date: 06/30/2011
22.
(Optional)
Additional
information
(Use
the
space
below
to
discuss
the
effectiveness
of
public
awareness
activities
funded
or
supported
by
your
State
Coalitions
Program
grant
and
to
provide
any
additional
information
you
would
like
to
share
about
your
public
awareness
activities
beyond
what
you
have
provided in
the
data
above.
An
example
might
include
developing
a
video
series
documenting
the
most
effective
advocacy
provided
to
victims
in
rural
communities,
resulting
in
more
awareness
of
the
challenges
and successes involved
in this
work
being
brought
to
community
events, and
training
sessions.)
(Maximum
-
2000
characters)
OMB Clearance # 1121-0280 Expiration Date: 07/31/2004
SECTION
reporting period? Check yes if State Coalitions Program-funded staff provided technical assistance or if State Coali- tions Program funds directly supported the provision of technical assistance.
Yes—answer
questions
23-25
No—skip
to
C6
23.
Number
of
technical
assistance
activities
(Report
the
total
number
of
technical
assistance
activities
pro-
vided
to
programs
during
the
current
reporting
period,
indicating
whether
they
were
site
visits
or
other
types
of
consultations.
Consultations
may
include
in-person,
telephonic,
electronic,
or
other
types
of
contact.
Each
contact
should
be
counted
as
one
activity.)
Recipients of technical assistance Number of site visits Number of other technical
assistance consultations
Batterer intervention program
Corrections (probation, parole, and correctional facility)
Court (state or local) Disability organization Domestic violence program
Dual sexual assault and domestic violence pro- gram
Elder organization
Faith-based organization Forensic examiner program Government agency
Health care provider (excluding forensic examiner)
Law enforcement (state or local)
Military command staff Other state coalition
Prosecutor’s office (state or local)
Tribal sexual assault or domestic violence pro- gram
University/school Youth program Other (specify):
TOTAL 0 0
State Coalitions Program Semi-annual Progress Report • 14 • Office on Violence Against Women
OMB Clearance # 1121-02 Expiration Date: 07/31/2004
Topics of technical assistance Sexual assault Domestic violence/ dating violence
Board development Civil codes
Coordinated community response Court response
Creating/sustaining diverse organizations Criminal codes
Curricula and training issues
Developing or enhancing appropriate services for elder victims
Developing
or
enhancing
appropriate
services
for
victims
who
have
disabilities
Developing or enhancing culturally appropriate services for underserved populations
Forensic evidence collection and documentation Grant writing/reporting
Law enforcement response Local policies and practices Program development Program evaluation
Probation and parole response Prosecution response
Response to dating violence victims/survivors Response to domestic violence victims/survivors Response to sexual assault victims/survivors Response to stalking victims/survivors
Safety planning Standards of service
State policies and practices
Technology and technology capacity (data collection systems and confidentiality)
Technology safety and security
Victim service administration and operations Other (specify):
OMB Clearance # 1122-0010 Expiration Date: 06/30/2011
25.
(Optional)
Additional
information
(Use
the
space
below
to discuss
the
effectiveness
of
technical
assistance
activities
funded
or
supported
by
your
State
Coalitions
Program
grant
and
to
provide
any
additional
information
you
would
like
to
share
about
your
technical
assistance
activities
beyond
what
you
have
provided in
the
data
above.
An
example
might
include
site visits
to
organizations
working
with
older
women
in
3
counties
to
document
best
practices
when
working
with
older
victims
of
domestic
violence,
resulting
in
open
conversations
with
those
providing
services
and
requests
for
more
training
on
effective
advocacy
for
this
underserved
population)
(Maximum
- 2000
characters).
State Coalitions Program Semi-annual Progress Report • 16 • Office on Violence Against Women
OMB Clearance # 1121-0280 Expiration Date : 07/31/2004
SECTION
member programs/agencies during the current reporting period? Check yes if State Coalitions Program-fund- ed staff were used to develop or enhance standards of service or if State Coalitions Program funds were used to directly support the development or enhancement of standards of service.
Yes—answer
question
26
No—skip
to
C7
26.
Development
or
enhancement
of
standards
of
service
for
member
programs/agencies
(Indicate
if
State
Coalitions
Program
funds
were
used
to
develop,
implement,
or
enhance
standards
of
service
or
provide
training
on
standards
of
service
for
member
programs.
Check
all
that
apply.)
Sexual assault Domestic violence/
dating Violence
Developing standards of service for member programs/agencies Implementing standards of service for members
Enhancing standards of service for member programs/agencies Training on standards of service for members
SECTION
served populations or to encourage the representation of underserved populations in coordination activi- ties during the current reporting period? Check yes if State Coalitions Program-funded staff were used to develop or enhance services for underserved populations or if State Coalitions Program funds directly supported representation of underserved populations in coordination activities.
Yes—answer
questions
27-29
No—skip
to
C8
27.
Activities
addressing
underserved
populations
(Check
all
activities
in
which
State
Coalitions
Program
funds
were
used
to develop
or
enhance
services
for
underserved
populations
or
to
encourage
the
representation
of
un-
derserved
populations
in
coordination
services.
Check
the
boxes
in
the
appropriate
columns
to indicate
whether
the
activities
you
engaged
in
were
for
sexual
assault
or
domestic
violence
programs/services.)
Activity Sexual
assault Domestic
violence/
dating
violence
Developing/distributing materials for underserved populations Developing policy
Identifying gaps in services Identifying underserved populations
Increasing organizational capacity for anti-oppression work
Supporting representatives of historically underserved groups to participate in meetings
Coordinating
a
task
force/caucus
to
address
issues
concerning
un-
derserved
populations
Training/technical assistance regarding culturally appropriate services for historically underserved populations
Other
(specify):
28.
Underserved
populations
(Indicate
which
underserved
populations
were
addressed
in
the
activities
indicated
in
question
27.
Check
all
that
apply.)
live
in
rural
areas
are
American
Indian
or
Alaska
Native
are
Asian
are
black
or
African
American
are
elderly
are Hispanic or Latino
are
homeless
or
living
in
poverty
are immigrants, refugees, or asylum seekers
are lesbian, gay, bisexual, transgender, or intersex are Native Hawaiian or other Pacific Islander
have
disabilitites
have
limited
English
proficiency
have
mental
health
issues
have
substance
abuse
issues
Other
(specify):
OMB Clearance # 1121-0280 Expiration Date: 07/31/2004
State Coalitions Program Semi-annual Progress Report • 18 • Office on Violence Against Women
OMB Clearance # 1122-0010 Expiration Date: 06/30/2011
29.
(Optional)
Additional
information
(Use
the
space
below
to
discuss
the
effectiveness
of
activities
to
reach
un-
derserved
populations
funded
or
supported
by
your
State
Coalitions
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
might
include:
We
are identifying gaps
in service
for
immigrants
and
refugees
in
our
state
through
inter-
views
with
service
providers
for
this
underserved
population.
This
has
resulted
in
the
identification
of
the
need
to
include
immigrants
and
refugees
in
two
upcoming
meetings
to
develop action
steps.)
(Maximum
-
2000
characters)
OMB Clearance # 1121-0280 Expiration Date: 07/31/2004
C8
SECTION
Were your State Coalitions Program funds used for organizational development and/or capacity building during the current reporting period? Check yes if State Coalitions Program-funded staff were used for organiza- tional development and/or capacity building activities or if State Coalitions Program funds were used to directly support organizational development and/or capacity building.
Yes—answer
questions
30-31
No—skip
to
Section
D
30.
Coalition
development
and
capacity
building
(Check
all
of
the
activities
that
were
engaged
in
with
State
Co-
alitions
Program
funds
during
the
current
reporting
period.)
Anti-oppression
work
Board
of
directors
Communication (TTY, language lines, etc.)
Emergency
preparedness
Equipment purchase (computers, printers, faxes, telephones, cell phones, etc.)
Evaluation/outcome
measures
Identifying
gaps
in
services
Internet
capacity/e-mail
accounts/listserv
Office
space
Outreach
to
diverse/underserved
populations
Personnel
policies
Software
purchase
or
development
Staff
development
Strategic
planning
Technology
security
and
safety
Toll-free
telephone
line
Web
site
development
or
enhancement
Other
(specify):
31.
Do
you
consider
system
privacy
and/or
security
when
purchasing
or
developing
software?
Yes
No
State Coalitions Program Semi-annual Progress Report • 20 • Office on Violence Against Women
SECTION
OMB Clearance # 1121-0280 Expiration Date : 07/31/2004
OMB Clearance # 1122-0010 Expiration Date: 06/30/2011
Please limit your response in the space provided.
32.
Report
on
the
status
of
the
goals
and
objectives
for
the
State
Coalitions
Program
grant.
(Report
on
the
status
of
the
goals
and
objectives
for
your
grant
as
of
the
end
of
the
current
reporting
period,
as
they
were
identified
in
your
grant
proposal
or
as
they
have been
added
or
revised.
Indicate
whether
the
activities
related
to
your
objectives
for
the
current
reporting
period
have
been
completed,
are
in
progress,
are
delayed,
or
have
been
revised.
Comment
on
your
successes
and
challenges,
and
provide
any
additional
explanation
you
feel
is
neces-
sary
for
us
to
understand
what
you
have or
have
not
accomplished
relative
to
your
goals
and
objectives.
If
you
have
not
accomplished
objectives
that
should
have been
accomplished
during
the
current
reporting
period,
you
must provide an explanation.)
Click here to answer
All
grantees
must
answer
questions
33
and
34
on
an
annual
basis.
Please
submit
this
information
on
the
January
to
June
reporting
form
only.
Please limit your response to two pages for each question. (Maximum 8000 characters)
33.
What
do
you
see
as
the
most
significant
areas
of
remaining
need
with
regard
to
improving
services
to
victims/survivors
of
sexual
assault,
domestic
violence,
dating
violence,
and
stalking,
increasing
victim/survivor
safety,
and
enhancing
community
response
(including
offender
accountability
for
both
batterers
and
sex
offenders)?
(Consider
geographic
regions,
underserved
populations,
service
delivery
systems, types of victimization, and challenges and barriers unique to your state.)
Click here to answer
34.
What
has
the
State
Coalitions
Program
funding
allowed
you
to
do
or
maintain
that
you
could
not
do
without
receiving
this
funding?
(For
example,
has
the
funding
enabled
you
to
identify
gaps
in
services,
improve
culturally
appropriate
services
to underserved
populations,
staff
coalition
office
full
time,
or
increase
the
participation
rate
of
historically
underserved
communities
in
coordination
meetings?
Provide
specific
examples
in
your answer.)
Click here to answer
Questions
35-36
are
optional.
Please limit your response to two pages for each question. (Maximum 8000 characters)
35.
Provide
any
additional
information
that
you
would
like
us
to
know
about
your
State
Coalitions
Pro-
gram
grant
and/or
the
effectiveness
of
your
grant.
(If
you
have
other
data
or
information
regarding
your
program
that
would
more
fully
or
accurately
reflect
the
effectiveness
of
your
State
Coalitions
Program
grant
than
the
data
you
have
been
asked
to
provide on
this
form,
answer
this
question.
If
you
have
not
already
done
so
else-
where
on
this
form,
you
may
want
to report
on
systems-level
changes,
community
collaboration,
the
removal
or
reduction
of
barriers
and
challenges
for
victims/survivors,
use
of
volunteers
and/or
interns
to
complete
activities,
promising practices, and positive or negative unintended consequences.)
Click here to answer
36.
Provide
any
additional
information
that
you
would
like
us
to
know
about
the
data
submitted.
(If
you
have
any information
that
could
be
helpful
in
understanding
the
data
you
have
submitted in
this
report,
please
answer
this
question.
For
example,
if
you
submitted
two
different
progress
reports
for
the
same
reporting
period,
you
may
explain
how
the
data
was
apportioned
to
each
report;
or
if
you
funded
staff—e.g.,
trainers—but
did
not
report
any
corresponding
training
activities,
you
may
explain
why;
or
if
you
did
not
use
program
funds
to support
either
staff
or
activities
during
the
reporting
period,
please
explain
how
program
funds
were
used,
if
you
have
not
already done so.)
Click here to answer
Public Reporting Burden
Paperwork Reduction Act Notice. Under the Paperwork Reduction Act, a person is not required to respond to a collection of information unless it displays a currently valid OMB control number. We try to create forms and instructions that are accurate, can be easily understood, and which impose the least possible burden on you to provide us with information. The estimated average time to complete and file this form is 60 minutes per form. If you have comments regarding the accuracy of this esti- mate, or suggestions for making this form simpler, you can write to the Office on Violence Against Women, U.S. Department of Justice, 800 K Street, NW, Washington, DC 20531.
THIS IS A SAMPLE GMS FORM. DO NOT USE THIS FORM TO SUBMIT YOUR FINAL DAOTMABTCOleOaVraWn.ce # 1122-0010
Expiration Date: 06/30/2011
Report
on the status of the goals and objectives for the State Coalitions
Program grant.
Question
32.
Back to Question
Status
(completed, in progress,delayed, revised)
Goals/Objectives (Describe your goals and objectives, as outlined in your grant proposal, or as revised)
Key Activities
Comments (successes, challenges, explanations)
(completed, in progress,delayed, revised)
Goals/Objectives (Describe your goals and objectives, as outlined in your grant proposal, or as revised)
Comments (successes, challenges, explanations)
OMB Clearance # 1122-0010
Expiration Date: 06/30/2011
Report on the status of the goals and objectives for the State Coalitions Program grant. Question 32 (cont.)
Back
to
Question
Status
(completed, in progress,delayed, revised)
Goals/Objectives (Describe your goals and objectives, as outlined in your grant proposal, or as revised)
Comments (successes, challenges, explanations)
(completed, in progress,delayed, revised)
Goals/Objectives (Describe your goals and objectives, as outlined in your grant proposal, or as revised)
Comments (successes, challenges, explanations)
THIS IS A SAMPLE GMS FORM. DO NOT USE THIS FORM TO SUBMIT YOUR FINAL DOAMTAB TCOleaOrVanWc.e # 1122-0010
Expiration Date: 06/30/2011
Report on the status of the goals and objectives for the State Coalitions Program grant. Question 32 (cont.)
OMB ClearanceNo.: 1121-
0280
Expiration Date: 07/31/2004
Status
(completed, in progress,delayed, revised)
Goals/Objectives (Describe your goals and objectives, as outlined in your grant proposal, or as revised)
Comments (successes, challenges, explanations)
(completed, in progress,delayed, revised)
Goals/Objectives (Describe your goals and objectives, as outlined in your grant proposal, or as revised)
Comments (successes, challenges, explanations)
THIS IS A SAMPLE GMS FORM. DO NOT USE THIS FORM TO SUBMIT YOUR FINAL DOAMTAB TCOleaOrVanWc.e # 1122-0010
Expiration Date: 06/30/2011
Report
on the status of the goals and objectives for the State Coalitions
Program grant.
Question
32 (cont.)
Status
(completed, in progress,delayed, revised)
Goals/Objectives (Describe your goals and objectives, as outlined in your grant proposal, or as revised)
Back to Question
Comments (successes, challenges, explanations)
(completed, in progress,delayed, revised)
Goals/Objectives (Describe your goals and objectives, as outlined in your grant proposal, or as revised)
Comments (successes, challenges, explanations)
OMB Clearance # 1121-028 Expiration Dat e: 07/31/2004
What do you see as the most significant areas of remaining need with regard to improving services to victims/survivors of sexual as- sault, domestic violence, dating violence, and stalking, increasing victim/survivor safety, and enhancing community response (includ-
ing
offender
accountability
for
both
batterers
and
sex
offenders)?
Question
#33
Back to Question
OMB Clearance # 1121-0280 Expiration Date: 07/31/2004
What do you see as the most significant areas of remaining need with regard to improving services to victims/survivors of sexual as- sault, domestic violence, dating violence, and stalking, increasing victim/survivor safety, and enhancing community response (includ-
ing
offender
accountability
for
both
batterers
and
sex
offenders)?
Question
#33
(cont.)
Back to Question
What has the State Coalitions Program funding allowed you to do or maintain that you could not do without receiving this funding?
Question #34 I Bae!< to QuesnOrtj
What has the State Coalitions Program funding allowed you to do or maintain that you could not do without receiving this funding? Question #34 (cont.) ICBacl< to Quesuotfj
Provide
any
additional
information
that
you
would
like
us
to
know
about
your
State
Coalitions
Program
grant
and/or
the
effectiveness
of
your
grant.
Question
#35
ICBack
to
QuestionJ
Provide any additional information that you would like us to know about your State Coalitions Program grant and/or the effectiveness of your grant. Question #35 (cont.) I Back to Quest1on j
Provide
any
additional
information
that
you
would
like
us
to
know
about
the
data
submitted.
Question
#36
1
Bae!<
fo
Question
j
State Coalitions Program Semi-annual Progress Report • 32 • Office on Violence Against Women
Provide any additional information that you would like us to know about the data submitted. Question #36 (cont.)
I Bacl<to QuestiottJ
MB ClearanceNo.: 1121-0280
piration Date: 07/31/2004
Ex Expiration Date: 06/30/2011
Validate
THIS IS A SAMPLE GMS FORM. DO NOT USE THIS FORM TO SUBMIT YOUR FINAL DATA TO OVW.
File Type | application/vnd.openxmlformats-officedocument.wordprocessingml.document |
File Title | COALITION_FORM |
Author | Sivakumar Kasi |
File Modified | 0000-00-00 |
File Created | 2021-01-21 |