Form 1122-0027 Semi Annual Progress REport for the Engaging Men Program

Semi- annual Progress Report for the Engaging Men Grant Program

EngagingMenandYouthGMSSample-1

Semi Annual Progress Reporting Form for the Engaging Men Grant Program

OMB: 1122-0027

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U.S. Department of Justice
Office on Violence Against Women
SEMI-ANNUAL PROGRESS REPORT FOR
Engaging Men and Youth in Preventing Sexual Assault, Domestic
Violence, Dating Violence, and Stalking Grant Program
Brief Instructions: This form must be completed for each Engaging Men and Youth in Preventing Sexual
Assault, Domestic Violence, Dating Violence, and Stalking Grant Program (Engaging Men and Youth Program)
grant received. A grant administrator or coordinator must ensure that the form is completed fully with regard
to all grant-funded activities. Grant partners, however, may complete sections relevant to their portion of the
grant. Grant administrators or coordinators are responsible for compiling and submitting a single report that
reflects all information collected from grant partners.
Following are some guidelines and examples regarding sections of this form that must be completed by
Engaging Men and Youth Program grantees:
• All grantees must complete the following: Subsection A1, Section B, Subsection C6, and Section D.
• In subsections A2, C1-C5, C7, and 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 subsection. If the response is no, the rest of that subsection is skipped.
For example,
1) If you are in the planning phase, you should complete A1, A2, B, C1, C6, and D.
2) If you are providing education programming with staff or volunteers and distributing manuals that
you developed under this grant, you should complete A1, A2, B, C4, C5, C6, C8, and D.
3) If you are providing training with staff funded under this grant, you should complete A1, A2, B, C2,
C6, and D.
The activities of volunteers or interns should be reported if they were coordinated or supervised by Engaging
Men and Youth Program-funded staff or if Engaging Men and Youth 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
Section A:
A1:
A2:
Section B:
Section C:
C1:
C2:
C3:
C4:
C5:
C6:
C7:
C8:
Section D:

General Information
Grant Information
Staff Information
Program Activities
Function Areas
Planning and Development
Training
Community Organizing/Mobilization and Prevention Activities
Public Education/Awareness Campaigns
Volunteer Activities
Coordinated Community Response
Policies
Products
Narrative

Page number
1
1
4
5
6
6
9
13
18
21
22
24
26
28

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A1

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GENERAL INFORMATION
Grant Information

All grantees must complete this subsection.

1. Date of report
2.

Current reporting period

(format date with 6 digits - 07/31/11)
✔

January 1-June 30

✔

July 1-December 31

(Year)

3. Grantee name
4. Grant number
ssss(the federal grant number assigned to your Engaging Men and Youth Program grant)
5. Type of grantee organization
(Check the one answer that best describes the type of agency/organization administering your
Engaging Men and Youth Program funds.)
Community-based child or youth services organization
Culturally specific services organization
Local government entity
Nonprofit, non-governmental domestic violence, dating violence, sexual assault, or stalking victim
services provider or coalition
State government entity
Territorial government entity
Tribal government entity
Other (specify):
5a. Specify type of grantee organization
(Provide additional information about the type of grantee organization. For example, if you checked
“state government entity” in question 5, and you are a state college, write the name of your college in the
space provided here. Or, if you checked “culturally specific services organization,” state the name of your
agency or briefly describe the specific populations with which you work.) (Maximum - 250 characters)

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

Telephone

Zip code

Facsimile

E-mail
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7. Is this a faith-based organization?
Yes
No
8.

Does this grant specifically address tribal populations?
(Check yes if your Engaging Men and Youth Program grant focuses on tribal populations and if so,
specify which tribes or nations.)
Yes
No
If yes, which tribes/nations (Maximum - 75 characters):

9.

Which culturally specific/underserved populations do you specifically address?
(Check the appropriate box(es), and elaborate below.)
Men and/or youth who:
are African
are American Indian or Alaska Native
are Asian
are black or African American
are D/deaf or hard of hearing
are gay, lesbian, bisexual, transgender, or intersex
are Hispanic or Latino
are homeless/runaway
are immigrants, refugees, or asylum seekers
are incarcerated/institutionalized
are Middle Eastern
are military personnel
are Native Hawaiian or Other Pacific Islander
are sexually exploited
belong to a particular religion/spiritual group (specify):
have disabilities
have limited English proficiency
have mental health issues
have substance abuse issues
live in rural areas
Other (specify):

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9a. Additional information
Provide additional information about the culturally specific/underserved populations you specifically
addressed. (For example, your public education/awareness campaign was launched within a
predominantly Hispanic neighborhood and included billboards in Spanish, or your community
organizing/mobilization efforts included a youth retreat with young Somali men.) (Maximum - 250
characters)

10. What percentage of your Engaging Men and Youth Program funds was directed to each of these
areas?
(Report the area(s) addressed by your Engaging Men and Youth Program grant during the current
reporting period and estimate the approximate percentage of funds [or resources] used to address
each area [consider community organizing, public education, etc.]. The grantee may choose how to
make this determination.)
Throughout this form, the term sexual assault includes both assaults committed by offenders who are
strangers to the victim/survivor and assaults committed by offenders who are known to, related by
blood or marriage to, or in a dating relationship with the victim/survivor. The term domestic violence
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. The term dating violence is defined as violence committed by
a person who is or has been in a social relationship of a romantic or intimate nature with the victim.
Stalking is defined as a course of conduct directed at a specific person that would cause a reasonable
person to fear for his or her safety or the safety of others, or suffer substantial emotional distress. (See
separate instructions for more complete definitions.)
Percentage of grant funds
Sexual assault
Domestic violence
Dating violence
Stalking
TOTAL (must equal 100%)

0

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STAFF INFORMATION

Were Engaging Men and Youth Program funds used to fund staff positions during the current reporting
period?
Check yes if Engaging Men and Youth Program funds were used to pay staff, including part-time staff
and contractors.
Yes--answer question 11
No--skip to Section B
11. Staff
(Report the number of full-time equivalent [FTE] staff funded by the Engaging Men and Youth 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 Engaging Men and Youth 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, project director)
Communications specialist (public awareness, media relations)
Community organizer
Educator/trainer
Information technology staff
Program coordinator (training coordinator, volunteer coordinator)
Support staff (secretary, administrative assistant, accountant, bookkeeper)
Translator/interpreter
Writer/editor
Other (specify):

TOTAL

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B

PROGRAM ACTIVITIES

All grantees must complete this subsection.

12. Program activities
(Check all program activities your Engaging Men and Youth program engaged in during the current
reporting period.)
Check ALL
that apply

Program activities
Create public education campaigns and community organizing to encourage men and
boys to work as allies with women and girls to prevent violence against women and girls
conducted by entities that have experience in conducting public education campaigns
that address domestic violence, dating violence, sexual assault, or stalking
Strategic radio PSAs and print materials (posters, brochures, and billboards, where
applicable) that provide men with a clear “call to action” to talk to youth and address
the importance of role modeling, and provide contact information for a violence
prevention organization in their community
Online resources that include relevant violence prevention information
Activities that engage men as influencers, or activities that highlight violence against
women prevention messages
Activities that encourage children and youth to pursue nonviolent relationships and
reduce their risk of becoming victims or perpetrators of domestic violence, dating
violence, sexual assault, or stalking; and that include at a minimum information on
domestic violence, dating violence, sexual assault, stalking, or child sexual abuse and
how they affect children and youth, and strategies to help participants be as safe as
possible

13. Program interest areas
(In addition to the program activities identified above, the Engaging Men and Youth Program
Solicitation may have encouraged several program interest areas. If your program addressed any of
these interest areas during the current reporting period, list them below.) (Maximum - 250 characters)

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FUNCTION AREAS
Planning and Development

Were your Engaging Men and Youth Program funds used for planning and development during the
current reporting period?
Check yes if you have Engaging Men and Youth Program funds and you are in the planning phase. Only
those grantees who received Engaging Men and Youth Program funds and who are in the planning
phase will answer questions 14-18.
Yes--answer questions 14-18
No--skip to Section C2
14. Planning and development meeting attendance
(Report the number of people attending planning and development meetings during the current
reporting period.)
Number of people attending
Number of meetings
15. Planning and development activities conducted (Check all that apply.)
Canvassing
Community forums
Cross training with MOU partners
Developing collaboration charter
Developing memo outlining specific forms of project
Developing needs assessment plan and tools
Developing needs assessment report
Developing strategic plan
Focus groups
Interviews with community leaders
Reviewing types of MOU partners
Surveys
Town hall meetings
Other (specify):

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16. Mandatory planning and development activities
(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 engaged in mandatory planning
and development activities 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
column, indicate the agencies or organizations with which you have an MOU for the purposes of the
Engaging Men and Youth grant.)
Meetings
MOU
Agency/organization
Weekly Monthly Quarterly partner
After school programs
Athletic teams/organizations
Batterer intervention programs
Children’s advocacy programs
Community advocacy groups (NAACP, etc.)
Community businesses (retail stores, barbershops, etc.)
Community service/civic groups (Kiwanis, Lions, Rotary, etc.)
Community leaders (city councilors, etc.)
Community members (unaffiliated adults)
Corrections (probation, parole, correctional facilities)
Courts
Culturally specific community groups
Dating violence programs (including teen dating violence)
Domestic violence programs
Dual programs (domestic violence and sexual assault)
Educational institutions
Enrichment programs
Faith-based organizations
Fatherhood groups
Fraternities
Gay, lesbian, bisexual, transgender organizations
Government agencies (Social Security, TANF, etc.)
Health/mental health organizations
Immigration organizations
Sexual assault programs
Sex offender management/sex offender treatment providers
Social service organizations (non-governmental)
Summer programs (non-governmental camps, parks and
recreation, etc.)
Tribal governments/tribal government agencies
Youth organizations (Boys & Girls Club, Boy Scouts, etc.)
Other (specify):
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17.

Technical assistance received during planning and development
(Report the number of site visits and/or consultations received from OVW TA providers during the
current reporting period.)

Technical assistance

Number of
site visits
conducted
by OVW TA
provider

Number of
consultations
conducted
by OVW TA
provider

Number of
OVW approved
workshops/
institutes/
training events

Collaboration/coordinated community response
Community engagement
Community organizing
Developing public education campaigns
Focus groups and interviews
Leadership development
Needs assessment plan and tools
Planning and implementation phase reports
Strategic planning
MOU partners
TOTAL
18.

0

0

0

(Optional) Additional information
(Use the space below to discuss the effectiveness of your planning and development activities funded
or supported by your Engaging Men and Youth Program grant and to provide any additional information
you would like to share about planning and development activities beyond what you have provided
in the data above. An example might include how the collaboration has been enhanced, or how the
capacity of the organizations involved in the collaborative has been improved.) (Maximum - 2000
characters)

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Training

Were your Engaging Men and Youth Program funds used for training during the current reporting period?
Check yes if Engaging Men and Youth Program-funded staff provided training, or if Engaging Men and
Youth Program funds directly supported the training.
Yes--answer questions 19-22
No--skip to Section C3
For the purposes of this reporting form, training means providing information on sexual assault, domestic
violence, dating violence, and stalking that enables professionals to improve their response to victims/
survivors as it relates to their role in the system.
19. Training events provided
Report the number of training events that were either provided by Engaging Men and Youth
Program-funded staff or directly supported by Engaging Men and Youth Program funds.

Number of training events provided

20.

Number of people trained
(Report the unduplicated number of people trained during the current reporting period by Engaging
Men and Youth Program-funded staff or training supported by Engaging Men and Youth Program funds.
Report the number of people trained in the appropriate column(s) and use the category that is most
descriptive of the people who attended the training event. Use the category “Multidisciplinary” only
as a last resort, when you are unable to provide a breakdown of the different types of professionals
who attended a training event. Students, community members, and victims should not be reported as
people trained, since they are not professionals. See separate instructions for examples.)
Number
Number who
who were
were not
Number
grant-funded grant-funded
People trained
of other
TOTAL
(grantee/
(grantee/
professionals
MOU
MOU
partners)
partners)

Advocacy organization staff (NAACP, etc.)

0

After school program staff

0

Athletic team/organization staff (coaches,
trainers, etc.)

0

Batterer intervention program staff

0

Child care staff

0

Children’s advocacy program staff

0

Community leaders (city councilors, school
board members, etc.)
Corrections personnel (probation, parole,
correctional facilities)
Court personnel

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0

0
0

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20.

Number of people trained (cont.)

People trained

Number
who were
grant-funded
(grantee/
MOU
partners)

Number who
were not
Number
grant-funded
of other
(grantee/
professionals
MOU
partners)

TOTAL

Culturally specific program staff (nongovernmental, does not include immigrant
organization staff)

0

Dating violence program staff (including
teen dating violence)

0

Domestic violence program staff

0

Dual program staff (domestic violence and
sexual assault)
Educators (teachers, administrators, etc. does not include university staff)

0
0

Faith-based organization staff

0

Gay, lesbian, bisexual, transgender
organization staff
Government agency staff (Social Security,
TANF, etc.)

0

0

Health/mental health organization staff

0

Immigrant/refugee organization staff

0

Law enforcement officers

0

Multidisciplinary

0

Sexual assault program staff

0

Sex offender management/sex offender
treatment providers
Social service organization staff (nongovernmental)
State or tribal coalition staff (includes
sexual assault, domestic violence, and
dual)
Summer program staff (non-governmental
camps, parks and recreation, etc.)
Tribal government/Tribal government
agency staff
University staff (resident advisors,
counselors, faculty, etc.)
Youth organization staff (Boys & Girls Club,
Boy Scouts, etc.)

0

0

0

0

0
0

0

Other (specify):
TOTAL

0
0

0

0

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21. Training content areas
(Indicate all topics covered in training events provided or directly supported with your Engaging Men
and Youth Program funds during the current reporting period. Check all that apply.)
Sexual assault, domestic violence, dating violence,
Issues specific to men and/or youth who:
and stalking
are African
Bystander/upstander intervention
are American Indian or Alaska Native
Child sexual abuse
are Asian
Community organizing/mobilizing
are black or African American
Dating violence overview, dynamics, and
are D/deaf or hard of hearing
services
are gay, lesbian, bisexual, transgender,
Domestic violence overview, dynamics, and
or intersex
services
are Hispanic or Latino
Domestic violence/dating violence prevention
are homeless/runaway
Digital abuse overview, dynamics, and services
are immigrants, refugees, or asylum
Gang affiliation
seekers
Healthy parenting/parenting skills
are incarcerated or institutionalized
Healthy relationships/domestic violence/dating
are Middle Eastern
violence prevention (elementary school)
are military personnel
Healthy relationships/domestic violence/dating
are Native Hawaiian or Other Pacific
violence prevention (middle school)
Islander
Healthy relationships/domestic violence/dating
are sexually exploited
violence prevention (high school)
belong to a particular religion/spiritual
Healthy relationships/domestic violence/dating
group (specify):
violence prevention (university)
have disabilities
Healthy relationships/domestic violence/dating
violence prevention (community)
have limited English proficiency
Leadership development
have mental health issues
Mandated reporting of child sexual abuse
have substance abuse issues
Men/boys as allies to women/girls
live in rural areas
Mentoring/role-modeling
Other (specify):
Safety planning (as bystanders or through
disclosures)
Self reflection
Sexual assault overview, dynamics, and
services
Stalking overview, dynamics, and services
Other (specify):

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22.

(Optional) Additional information
(Use the space below to discuss the effectiveness of training activities funded or supported by your
Engaging Men and Youth 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. An example
might include improved understanding of the impact men can have on male youth following a training
provided to a group of social service organization staff.) (Maximum - 2000 characters)

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C3

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COMMUNITY ORGANIZING/MOBILIZATION
AND PREVENTION ACTIVITIES

Were your Engaging Men and Youth Program funds used for community organizing/mobilization and/or
prevention activities during the current reporting period?
Check yes if Engaging Men and Youth Program-funded staff engaged in community organizing/
mobilization and/or prevention activities or if Engaging Men and Youth Program funds were used to
directly support the community organizing/mobilization and/or prevention activities.
Yes--answer questions 23-27
No--skip to Section C4
23.

Events provided
(Report the number and type of events that were either provided by Engaging Men and Youth Programfunded staff or directly supported with Engaging Men and Youth Program funds as part of your
community organization/mobilization and/or prevention efforts. Also report the total number of people
who attended each event by the type of event.)
Type of event

Number of
events

Number of
people

Cultural arts
Culturally specific event
Information table
Pledge drive
Public forum
Rally
School presentation (one-time assembly, theater production, etc.)
Speak out
Walk/run
Other (specify):
24.

Venue at which events were held
(For the events reported in 23, check the appropriate box(es) for each venue at which an event was
held. Check all that apply.)
College/university
Community business (retail stores, barbershops, etc.)
Community fair/event
Cultural event (festivals, culinary events, etc.)
Elementary school
High school
Middle school
Online/web (social networking, webinar, live chat, etc.)
Sporting event
Religious institution (church, synagogue, mosque, etc.)
Tribal land/reservation
Other (specify):
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25. Ongoing activities
(Report the number of each type of activity in the appropriate column. Report the total number of
people reached within each category under the appropriate column for each type of activity in which
people were engaged. The number of people reported should be an unduplicated count. See separate
instructions for examples.)
Self
Educational reflection/
course
support
group

Retreat/
outing

Online
social
media

Leadership/
mentoring
training

Other
(specify):

Total number of
activities:
People reached:
After school program staff
(e.g., Boys and Girls Club)
Athletes (adults)
Athletes (youth)
Coaches
Community advocacy
group members (NAACP,
etc.)
Community business
owners/employees (retail
stores, barbershops, etc.)
Community service/civic
group members (Kiwanis,
Lions, Rotary, etc.)
Community leaders (city
councilors, school board
members, etc.)
Community members
(unaffiliated adults)
Culturally specific
community group
members (adults)
Culturally specific
community group
members (youth)
Educators (faculty, staff,
administrators, etc.)
Ex-offenders (adults)
Ex-offenders (youth)
Faith-based group
members (adults)
Faith-based group
members (youth)
Fatherhood group
members

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25.

Ongoing activities (cont.)
(Report the number of each type of activity in the appropriate column. Report the total number of
people reached within each category under the appropriate column for each type of activity in which
people were engaged. The number of people reported should be an unduplicated count.)
Self
Educational reflection/
course
support
group

Retreat/
outing

Online
social
media

Leadership/
mentoring
training

Other
(specify):

Fraternity members
Gay/lesbian/bisexual/
transgender/intersex
(adults)
Gay/lesbian/bisexual/
transgender/intersex
(youth)
Health/mental health
professionals
Immigrant/refugee
organization members
(adults)
Immigrant/refugee
organization members
(youth)
Mentoring program staff
(Big Brothers, etc.)
Parents or guardians
Students (elementary
school)
Students (middle school)
Students (high school)
Students (university or
college)
Youth organization
members (Boy Scouts,
etc.)
Other (specify):

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26. Topics of community organizing/mobilization events provided with Engaging Men and Youth
Program funds
(Indicate all topics covered in community education/mobilization and/or prevention events provided
with your Engaging Men and Youth Program funds during the current reporting period. Check all that
apply.)
Sexual assault, domestic violence, dating violence,
Issues specific to men and/or youth who:
and stalking
are African
Bystander/upstander intervention
are American Indian or Alaska Native
Child sexual abuse
are Asian
Community organizing/mobilizing
are black or African American
Dating violence overview, dynamics, and
are D/deaf or hard of hearing
services
are gay, lesbian, bisexual, transgender,
Domestic violence overview, dynamics, and
or intersex
services
are Hispanic or Latino
Domestic violence/dating violence prevention
are homeless/runaway
Digital abuse overview, dynamics, and services
are immigrants, refugees, or asylum
Gang affiliation
seekers
Healthy parenting/parenting skills
are incarcerated or institutionalized
Healthy relationships/domestic violence/dating
are Middle Eastern
violence prevention (elementary school)
are military personnel
Healthy relationships/domestic violence/dating
are Native Hawaiian or Other Pacific
violence prevention (middle school)
Islander
Healthy relationships/domestic violence/dating
are sexually exploited
violence prevention (high school)
belong to a particular religion/spiritual
Healthy relationships/domestic violence/dating
group (specify):
violence prevention (university)
have disabilities
Healthy relationships/domestic violence/dating
violence prevention (community)
have limited English proficiency
Leadership development
have mental health issues
Mandated reporting of child sexual abuse
have substance abuse issues
Men/boys as allies to women/girls
live in rural areas
Mentoring/role-modeling
Other (specify):
Safety planning (as bystanders or through
disclosures)
Self reflection
Sexual assault overview, dynamics, and
services
Stalking overview, dynamics, and services
Other (specify):

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27.

(Optional) Additional information
(Use the space below to discuss the effectiveness of community organizing/mobilization and/
or prevention activities funded or supported by your Engaging Men and Youth Program grant and
to provide any additional information you would like to share about your community organizing/
mobilization and/or prevention activities beyond what you have provided in the data above.
An example might include discussing the success of a pledge drive with the local fraternity.)
(Maximum - 2000 characters)

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C4

OMB Clearance # 1122-0027
Expiration Date 06/30/2018

PUBLIC EDUCATION/AWARENESS CAMPAIGNS

Were your Engaging Men and Youth Program funds used for broad-based public education/awareness
campaigns during the current reporting period?
Check yes if Engaging Men and Youth Program-funded staff conducted public education/awareness
campaign activities or if Engaging Men and Youth Program funds were used to directly support public
education/awareness campaign activities.
Yes--answer questions 28-31
No--skip to Section C5
28.

Public education/awareness campaign activities
(Indicate the public education/awareness campaign activities that were supported with Engaging Men
and Youth Program funds during the current reporting period.)
Type of activity

Number

Billboards
Bus shelter/bus/taxi advertisements
Contests
Media articles/opinion editorials
Merchandising (T-shirts, mugs, magnets, etc.)
Online social media (Facebook, Twitter, etc.)
Poster campaign
Press conferences
Print (magazines, newspapers, brochures, etc.)
Radio advertisements
Sponsorships (concerts, sporting events, etc.)
Television advertisements
Web-based video/internet advertisements (e.g.,YouTube)
Other (specify):

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29.

Intended audience of your public education/awareness campaign activities with Engaging Men
and Youth Program funds
(Check all that apply.)
Men/youth who:
are African
are American Indian or Alaska Native
are Asian
are athletes
are black or African American
are business owners
are coaches
are D/deaf or hard of hearing
are educators (faculty, staff, administrators)
are elementary school students
are ex-offenders
are faith-based group members
are fathers/father-figures/caregivers
are fraternity members
are gay/lesbian/bisexual/transgender/intersex
are high school students
are Hispanic/Latino
are immigrants
are Middle Eastern
are middle school students
are military personnel
are Native Hawaiian or Other Pacific Islander
are university/college students
have disabilities
live in rural areas
live in urban communities
Other (specify):

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30. Topics of public education/awareness activities provided with Engaging Men and Youth Program
funds
(Indicate all topics covered in public education/awareness activities provided with your Engaging Men
and Youth Program funds during the current reporting period. Check all that apply).
Sexual assault, domestic violence, dating violence, and stalking
Bystander/upstander intervention
Child sexual abuse
Dating violence, overview, dynamics, and services
Domestic violence, overview, dynamics, and services
Domestic violence/dating violence prevention
Digital abuse overview, dynamics, and services
Gang affiliation
Healthy parenting/parenting skills
Healthy relationships/domestic violence/dating violence prevention (elementary school)
Healthy relationships/domestic violence/dating violence prevention (middle school)
Healthy relationships/domestic violence/dating violence prevention (high school)
Healthy relationships/domestic violence/dating violence prevention (university)
Healthy relationships/domestic violence/dating violence prevention (community)
Leadership development
Mandated reporting of child sexual abuse
Men/boys as allies to women/girls
Mentoring/role-modeling
Safety planning (as bystanders or through disclosures)
Self-reflection
Sexual assault overview, dynamics, and services
Stalking overview, dynamics, and services
Other (specify):
31. (Optional) Additional information
(Use the space below to discuss the effectiveness of public education/awareness campaign activities
funded or supported by your Engaging Men and Youth Program grant and to provide any additional
information you would like to share about your public education/awareness campaign activities
beyond what you have provided in the data above. An example might include discussing pre- and posttest surveys indicating a increase in knowledge of dating violence among high school students as a
result of your public education campaign. (Maximum - 2000 characters)

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C5

VOLUNTEER ACTIVITIES

Were your Engaging Men and Youth Program funds used for volunteer development during the current
reporting period?
Check yes if Engaging Men and Youth Program-funded staff conducted volunteer development activities
or if Engaging Men and Youth Program funds were used to directly support volunteer development
activities.
Yes--answer questions 32-34
No--skip to Section C6
32. Number of volunteers
(Report the number of volunteers recruited and trained using Engaging Men and Youth Program
funds during the current reporting period. Volunteers are unpaid persons acting on behalf of your
organization who engage in activities such as community mobilization, public education, and
mentoring.)
Number of volunteers
Recruited
Trained
33. Volunteer activities
(Report the number of volunteers who engaged in each type of activity funded or supported by your
Engaging Men and Youth Program grant during the current reporting period.)
Type of activity

Number of volunteers

Community organizing/mobilization
and/or prevention activities
Mentoring
Public education/awareness campaigns
Other (specify):
TOTAL
34.

0

(Optional) Additional information
(Use the space below to discuss the effectiveness of volunteers funded or supported by your Engaging
Men and Youth Program grant and to provide any additional information you would like to share
about volunteer activities beyond what you have provided in the data above. An example might
include discussing the success of trained volunteers who were former high school football players
who returned to their high school to discuss issues of dating violence with the school’s football team.)
(Maximum - 2000 characters)

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C6

OMB Clearance # 1122-0027
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COORDINATED COMMUNITY RESPONSE
All grantees must complete this subsection.

35. Coordinated community response activities
(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 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 column, indicate the agencies or organizations with which you
have an MOU for purposes of the Engaging Men and Youth grant. If Engaging Men and Youth Programfunded 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.)
Agency/organization

Consultations,
technical assistance
Daily
Weekly Monthly

Meetings
Weekly

Monthly Quarterly

MOU
partner

After school program
Athletic team/organization
Batterer intervention program
Children’s advocacy program
Community advocacy group
(NAACP, etc.)
Community business (retail
store, barbershop, etc.)
Community service/civic group
(Kiwanis, Lions, Rotary, etc.)
Community leader (city
councilor, etc.)
Community member
(unaffiliated adult)
Corrections (probation, parole,
and correctional facility)
Court
Culturally specific community
group
Domestic violence organization
Dual organization (Domestic
violence and sexual assault)
Educational institution
Enrichment program
Faith-based organization
Fatherhood group
Fraternity
Gay, lesbian, bisexual,
transgender organization
Government agency (Social
Security, TANF, etc.)

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35. Coordinated community response activities (cont.)
Agency/organization

Consultations,
technical assistance
Daily
Weekly Monthly

Meetings
Weekly

Monthly Quarterly

MOU
partner

Health/mental health
organization
Immigrant organization
Law enforcement agency
Sexual assault organization
Sex offender management/sex
offender treatment provider
Social service organizations
(non-governmental)
Summer program (nongovernmental camp, parks and
recreation, etc.)
Tribal government/tribal
government agency
Youth organization (Boy Scouts,
etc.)
Other (specify):

36. (Optional) Additional information
(Use the space below to discuss the effectiveness of coordinated community response [CCR] activities
funded or supported by your Engaging Men and Youth Program grant and to provide any additional
information you would like to share about your CCR activities beyond what you have provided in the
data above. Examples might include weekly meetings held with the Boys and Girls Club to discuss
possible prevention activities.) (Maximum – 2000 characters)

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C7

OMB Clearance # 1122-0027
Expiration Date 06/30/2018

POLICIES

Were your Engaging Men and Youth Program funds used to develop, substantially revise, or implement
policies during the current reporting period?
Check yes if Engaging Men and Youth Program-funded staff developed, substantially revised, and/or
implemented policies or protocols, or if Engaging Men and Youth Program funds directly supported the
development, revision, and/or implementation of policies or protocols.
Yes--answer questions 37-38
No--skip to Section C8
37. Types of policies or protocols developed, substantially revised, or implemented during the current
reporting period
(Check all that apply)
Sexual assault, domestic violence, dating violence, and stalking
Access to translators/interpreters
Appropriate use of translators/interpreters
Appropriate and safe response to dating violence
Appropriate and safe response to domestic violence
Appropriate and safe response to sexual assault
Appropriate and safe response to stalking
Appropriate response to victims/survivors with substance abuse issues and/or mental health
diagnoses
Background checks for staff and volunteers
Confidentiality
Coordinated community response
Cross-training between community organizations
Culturally and linguistically appropriate response to underserved populations
Data collection
Developing/distributing materials for underserved populations
Identifying gaps in services
Mandatory reporting
Mandatory training standards for staff and volunteers
Needs assessment
Parental consent
Parent notification procedure
Procedures for anonymous, confidential, or Jane Doe reporting of sexual assault
Protocols with school police/security
Referral procedure for dating violence
Referral procedure for domestic violence
Referral procedure for sexual assault
Referral procedure for stalking
Staff development
Strategic planning
Supporting representatives of historically underserved groups to participate in meetings
Other (specify):

Engaging Men and Youth Program Semi-annual Progress Report • 24 • Office on Violence Against Women

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38.

(Optional) Additional information
(Use the space below to discuss the effectiveness of policies you have developed, substantially revised,
or implemented that were funded or supported by your Engaging Men and Youth 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. Examples might include improved advocacy response following
implementation of a protocol that provides employees with detailed information about the issues of
mandatory reporting for youth victims or working with project partners to ensure that organizational
policies are responsive to the needs of youth.) (Maximum – 2000 characters)

Engaging Men and Youth Program Semi-annual Progress Report • 25 • Office on Violence Against Women

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C8

PRODUCTS

Were your Engaging Men and Youth Program funds used to develop, substantially revise, or distribute
products during the current reporting period?
Check yes if Engaging Men and Youth Program-funded staff developed products or if Engaging Men and
Youth Program funds directly supported the development, revision, or distribution of products.
Yes--answer question 39
No--skip to Section D
39. Use of Engaging Men and Youth Program funds for product development, substantial revision, or
distribution
(Report the number of products developed, substantially revised, or distributed with Engaging Men and
Youth 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, revised, 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 developed 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 reporting
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

Title/topic

Intended
audience

Number
used or
distributed

Other
languages

Brochures

Fact sheets

Posters

Manuals

Engaging Men and Youth Program Semi-annual Progress Report • 26 • Office on Violence Against Women

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39.

Use of Engaging Men and Youth Program funds for product development, substantial revision, or
distribution (cont.)
Number
developed
or revised

Products

Title/topic

Intended
audience

Number
used or
distributed

Other
languages

Newsletters

Toolkits

Training
curricula

Training
materials

Reports

Websites (report number
of page views
in the used
or distributed
column)

Videos

Other
(specify):

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D

OMB Clearance # 1122-0027
Expiration Date 06/30/2018

NARRATIVE

All grantees must answer question 40.
Please limit your response to four pages for this question.
40. Report on the status of the goals and objectives for your Engaging Men and Youth 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 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 have been accomplished during the current reporting period, you must provide an explanation.)
Page 29

All grantees must answer questions 41-42 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.
41. What do you see as the most significant areas of remaining need with regard to increasing safety
for victims/survivors of sexual assault, domestic violence, dating violence, and stalking, and
enhancing community response (including offender accountability for both batterers and sex
Page 32
offenders)?
(Consider geographic regions, underserved populations, service delivery systems, types of
victimization, and challenges and barriers unique to your community.)
42.

What has the Engaging Men and Youth Program funding allowed you to do or maintain that you
Page 34
could not do without receiving this funding?
(For example you created a radio ad featuring male members of a local sports team speaking out
against sexual assault, domestic violence, dating violence, and stalking.)

Questions 43-44 are optional.
Please limit your response to two pages for each question.
43.

Provide any additional information that you would like us to know about your Engaging Men and
Youth Program 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 Engaging Men and Youth Program grant than the data you have been
asked to provide on this form, answer this question. If you have not already done so elsewhere on this
form, you may want to report on community collaboration, the increased number of men engaging in
prevention activities and what types of actions they are taking, promising practices, and positive or
negative unintended consequences, such as how women in your community feel about your engaging
Page 36
men efforts.)
44. 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., educators—but did not report any corresponding education 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.)
Page 38
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 estimate, or suggestions for making this form simpler, you can write to the
Office on Violence Against Women, U.S. Department of Justice, 145 N Street, NE, Washington, DC 20531.

Engaging Men and Youth Program Semi-annual Progress Report • 28 • Office on Violence Against Women

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OMB Clearance # 1122-0027
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Report on the status of your Engaging Men and Youth Program grant goals and objectives as of the end of
the current reporting period. Question #40

Goals/Objectives (1,750 characters)

Status
(100 characters)

Key Activities (1,750 characters)

Comments (500 characters)

Goals/Objectives

Status

Key Activities

Comments

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OMB Clearance # 1122-0027
Expiration Date 06/30/2018

Report on the status of your Engaging Men and Youth Program grant goals and objectives as of the end of
the current reporting period. Question #40 (cont. 1)
Goals/Objectives

Status

Key Activities

Comments

Goals/Objectives

Status

Key Activities

Comments

Engaging Men and Youth Program Semi-annual Progress Report • 30 • Office on Violence Against Women

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Back to Instructions.

OMB Clearance # 1122-0027
Expiration Date 06/30/2018

Report on the status of your Engaging Men and Youth Program grant goals and objectives as of the end of
the current reporting period. Question #40 (cont. 2)
Goals/Objectives

Status

Key Activities

Comments

Goals/Objectives

Status

Key Activities

Comments

Engaging Men and Youth Program Semi-annual Progress Report • 31 • Office on Violence Against Women

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Back to Instructions.

OMB Clearance # 1122-0027
Expiration Date 06/30/2018

What do you see as the most significant areas of remaining need with regard to increasing safety
for victims/survivors of sexual assault, domestic violence, dating violence and stalking, 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 community.) Question #41

Engaging Men and Youth Program Semi-annual Progress Report • 32 • Office on Violence Against Women

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Back to Instructions.

OMB Clearance # 1122-0027
Expiration Date 06/30/2018

What do you see as the most significant areas of remaining need with regard to increasing safety
for victims/survivors of sexual assault, domestic violence, dating violence, and stalking, 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 community.) Question #41 (cont.)

Engaging Men and Youth Program Semi-annual Progress Report • 33 • Office on Violence Against Women

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Back to Instructions.

OMB Clearance # 1122-0027
Expiration Date 06/30/2018

What has the Engaging Men and Youth Program funding allowed you to do or maintain that you could
not do without receiving this funding? (For example you created a radio ad featuring male members of a
local sports team speaking out against sexual assault, domestic violence, dating violence, and stalking.)
Question #42

Engaging Men and Youth Program Semi-annual Progress Report • 34 • Office on Violence Against Women

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Back to Instructions.

OMB Clearance # 1122-0027
Expiration Date 06/30/2018

What has the Engaging Men and Youth Program funding allowed you to do or maintain that you could
not do without receiving this funding? (For example you created a radio ad featuring male members of a
local sports team speaking out against sexual assault, domestic violence, dating violence, and stalking.)
Question #42 (cont.)

Engaging Men and Youth Program Semi-annual Progress Report • 35 • Office on Violence Against Women

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Back to Instructions.

OMB Clearance # 1122-0027
Expiration Date 06/30/2018

Provide any additional information that you would like us to know about your Engaging Men and Youth
Program 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 Engaging Men and Youth
Program grant than the data you have been asked to provide on this form, answer this question. If you
have not already done so elsewhere on this form, you may want to report on community collaboration,
the increased number of men engaging in prevention activities and what types of actions they are taking,
promising practices, and positive or negative unintended consequences, such as how women in your
community feel about your engaging men efforts.) Question #43

Engaging Men and Youth Program Semi-annual Progress Report • 36 • Office on Violence Against Women

THIS IS A SAMPLE GMS FORM. DO NOT USE THIS FORM TO SUBMIT YOUR FINAL DATA TO OVW.
Back to Instructions.

OMB Clearance # 1122-0027
Expiration Date 06/30/2018

Provide any additional information that you would like us to know about your Engaging Men and Youth
Program 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 Engaging Men and Youth
Program grant than the data you have been asked to provide on this form, answer this question. If you
have not already done so elsewhere on this form, you may want to report on community collaboration,
the increased number of men engaging in prevention activities and what types of actions they are taking,
promising practices, and positive or negative unintended consequences, such as how women in your
community feel about your engaging men efforts.) Question #43 (cont.)

Engaging Men and Youth Program Semi-annual Progress Report • 37 • Office on Violence Against Women

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OMB Clearance # 1122-0027
Expiration Date 06/30/2018

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.,
educators—but did not report any corresponding education 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.) Question #44

Engaging Men and Youth Program Semi-annual Progress Report • 38 • Office on Violence Against Women

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OMB Clearance # 1122-0027
Expiration Date 06/30/2018

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.,
educators—but did not report any corresponding education 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.) Question #44 (cont.)

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