ECSH Program Data Indicators

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Ethnic Commnity Self-Help (ECSH) Program Data Indicators
1. Grantee Name:
2. Grant Number:
3. Reporting Period End Date:

DIRECT SERVICES
Program Activities
4. Number of New Enrollments this Reporting
Period
5. Number of Refugees Served
6. Number of Clients Served According to
Status
6a. Refugee
6b. Asylee

First Reporting
Period

Second Reporting
Period

Cumulative Budget Period

First Reporting
Period

Second Reporting
Period

Cumulative Budget Period

6c. Other status eligible for ORR services

7. Types of Services Provided
7a. Navigation Services
7b. Cultural/community orientation
7c. Health-related services
7d. Home management services
7e. Transportation
7f. Translation and interpretation
services
7g. Case management services
7h. English language training
7i. Employability services
7j. Academic enrichment/college
preparation
7k. Emotional wellness services

First Reporting Second Reporting
Period
Period
Yes ('1')/No ('0') Yes ('1')/No ('0')

7l. Referral services
7m. Citizenship preparation/civic
engagement
7n. Other (list):

ORGANIZATIONAL DEVELOPMENT
Program Activities

First Reporting
Period

Second Reporting
Period

Cumulative Budget Period

First Reporting
Period

Second Reporting
Period

Cumulative Budget Period

8. Number of New Partnerships Developed
9. Type of New Partnership Developed

9a. Educational organization
9b. Local/state government entity
9c. Medical service provider
9d. Legal service provider
9e. Faith-based group
9f. Other (list)
10. Types of Training Provided to Staff
10a. Case management
10b. Case documentation
10c. Interpretation
10d. Cultural sensitivity and awareness
10e. Self-care
10f. Cultural orientation provision
10g. Public benefits
10h. Health services and systems
10i. Non-profit management
10j. Other (list)

First Reporting Second Reporting
Period
Period
Yes ('1')/No ('0') Yes ('1')/No ('0')

CIVIC ENGAGEMENT
11. Types of Community Engagement
Activities Conducted

First Reporting Period

Second Reporting Period

LOGIC MODEL OUTPUTS & OUTCOMES
Logic Model Outputs Progress
Please list all planned Outputs from the Logic
Model in the following spaces. Add more
spaces as necessary.

Logic Model Outcomes Progress
Please list all planned Outcomes from the
Logic Model in the following spaces. Add more
spaces as necessary.

Semi-Annual Results
First Reporting Period
Second Reporting Period
Identify progress towards each Output
for Months 1-6

Identify progress towards each
Output for Months 7-12.

Semi-Annual Results
First Reporting Period
Second Reporting Period
Identify progress towards each
Outcomes for Months 1-6

Identify progress towards each
Outcomes for Months 7-12.

THE PAPERWORK REDUCTION ACT OF 1995 (Pub. L. 104-13): Public reporting burden for this collection of information is estimated to average 2 hours per
response, including the time for reviewing instructions, gathering and maintaining the data needed, and reviewing the collection of information. An agency may
not conduct or sponsor, and a person is not required to respond to, a collection of information unless it displays a currently valid OMB control number.

OMB Control Number: 0970-0490
Expiration Date: 1/31/2020

Cumulative Budget Period
Describe progress towards Outputs
for the current fiscal year.

Cumulative Budget Period
Describe progress towards each
Outcome for the current fiscal year.

mation is estimated to average 2 hours per
ng the collection of information. An agency may
a currently valid OMB control number.