3C Reporting Template

P S18-1807 Component 3C Reporting Template

Site Name: Click or tap here to enter text. Grant #: PS00xxxx

Timeframe: ☐ August 1, 20xx – January 31, 20xx ☐ February 1, 20xx – July 31, 20xx

DASH Program Consultant:

Activities	Components Requested
	Level of Completion		Comment and/or Summarize Requirement Progress	TA Tier and Specific C2 LEA Recipients Supported	Collaborating Component 3 Recipients
	Please indicate the level of completion of each activity.		Please summarize or provide additional detail on requirement progress as needed.	Please identify the C2 Recipient(s) AND Tier of TA Received (Universal/Targeted/ Intensive) for each activity. Ex. Albuquerque - Universal	Please identify any other C3 Recipients engaged in each activity.
This was a required activity for Year 1 of PS18-1807. It does not need to be completed again in subsequent years. 3C 1. Submit a revised work plan that reflects an overall approach to achieve the project outcomes with specific and appropriate timelines tailored to the specific needs of recipients of C2 funding. Implement activities that are evidence-based, achievable, and appropriate to achieve the outcomes of the project.	☐ Completed ☐ In Progress ☐ Not started
3C 2. Work collaboratively with staff in the LEA funded for C2 to implement the approach and the required activities to achieve program performance outcomes.	☐ Completed ☐ In Progress ☐ Not started
3C 3. Submit an annual professional development work plan beginning in year 2 in consultation with the CDC professional development and evaluation contractor.	☐ Completed ☐ In Progress ☐ Not started
3C 4. Work collaboratively with the CDC professional development and evaluation contractor to address the capacity building needs of the recipients awarded under C2.	☐ Completed ☐ In Progress ☐ Not started
3C 5. Create and implement an annual inventory of general program activities of all LEA funded for C2 related to SSE, including specific LGBT-focused programmatic and capacity building activities.	☐ Completed ☐ In Progress ☐ Not started
3C 6. Create and implement an annual assessment of the capacity of all LEA funded for C2 to implement activities in SSE.	☐ Completed ☐ In Progress ☐ Not started
3C 7. Create and implement an annual inventory of general SSE or LGBT-focused program activities among recipients.	☐ Completed ☐ In Progress ☐ Not started
3C 8. Provide technical assistance to LEA funded for C2 to strengthen SSE, consistent with needs assessment results, through a tiered plan to build the capacity of those LEA that includes general technical assistance, specialized capacity building, and intensive program implementation support.	☐ Completed ☐ In Progress ☐ Not started
3C 9. Identify, synthesize, and disseminate existing resources to support efforts of LEA funded for C2 to improve SSE in high schools and middle schools, including resources to improve SSE for LGBT youth.	☐ Completed ☐ In Progress ☐ Not started
3C 10. Assess training and technical assistance needs of LEA funded for C2 including staff within schools where activities are being implemented.		☐ Completed ☐ In Progress ☐ Not started
3C 11. Provide and/or connect staff of LEA funded for C2 to professional development, training, and technical assistance on implementing the required activities.		☐ Completed ☐ In Progress ☐ Not started
3C 12. Work with CDC to collect and disseminate success stories as accomplishments or milestones are achieved that highlight the progress made by C2 recipients.		☐ Completed ☐ In Progress ☐ Not started
Evaluation Activities: Please share any evaluation efforts and updates (i.e., reports, 1-pager, infographics, conference abstracts, developing systems to capture referrals, technical assistance, etc.) developed during the reporting period: Click or tap here to enter text.
Successes: Please describe any additional successes (e.g., identified through evaluation results or lessons learned). Click or tap here to enter text.
Challenges: Please describe any challenges that might affect your ability to achieve annual and project-period outcomes, conduct performance measures, or complete the activities in the work plan. Also please describe any additional challenges (e.g., identified through evaluation results or lessons learned). Click or tap here to enter text.
CDC Program Support to Awardees: Please describe how CDC could help you overcome challenges to achieving annual and project-period outcomes, and performance measures, and completing activities outlined in the work plan. Click or tap here to enter text.