Form ETA 9136 ETA 9136 MIS System, Quarterly Report

YouthBuild Reporting System

OMB approved YB MIS Form.xls

Quarterly Performance Report

OMB: 1205-0464

Document [xlsx]
Download: xlsx | pdf
STANDARDIZED QUARTERLY PERFORMANCE REPORT





















YouthBuild (YB) GRANT





















ETA - 9136






OMB No. 1205-0464























Report Due Date: mm/dd/yyyy






Expires: xx/xx/xxxx






















A. GRANTEE IDENTIFYING INFORMATION





















Grantee Name: Grant Number:











































Program/Project Name: Project or Sub-Project ID/Number:











































Report Quarter End Date:


















































City ________________________________

State ______ Zip Code __________

Enrollment Goal:






















Performance Items Previous Quarter
(A)
Current Quarter
(B)
Cumulative for Program Year
(C)
Program-to-Date
(D)






















B. PARTICIPANT SUMMARY INFORMATION





















1. Total Exiters

























2. Total Participants Served

























3. New Participants Served

























Gender 4a. Male

























4b Female

























Ethnicity / Race 5a. Hispanic/Latino

























5b. American Indian or Alaska Native

























5c. Asian

























5d Black or African American

























5e. Hawaiian Native or Other Pacific Islander

























5f. White

























Education Level 6a. 8th grade and under





























6b. 9th grade - 12th grade





























6c. High School graduate or equivalent





























6d. 1 - 3 years of college, or full-time technical or vocational school





























6e. 4 years college or more





























Other Demographics 7. Limited English Proficient





























8. Low Income





























9. Foster Youth





























10. Migrant Youth





























11. High School Drop-Out





























12. Youth Offender





























13. Adult Offender





























14. Basic Skills Deficient





























15. Child of Incarcerated Parent






























16. Persons with a Disability






























17. Not Employed at Program Enrollment





























Performance Items

Previous Quarter
(A)

Current Quarter
(B)
Cumulative for Program Year
(C)
Program-to-Date
(D)






















Value Numerator Value Numerator Value Numerator Value Numerator





















Denominator Denominator Denominator Denominator





















C. PROGRAM SERVICES, ACTIVITIES, AND OTHER RELATED ASSISTANCE























1. Received Education or Job Training Activities























































2. Received Workforce Preparation Activities























































3. Community Involvement & Leadership Development Activities























































4. Post Secondary Exploration and Planning Activities























































5. Received Mentoring Activities























































6. Received Health Services























































7. Received Supportive Services























































D. SHORT-TERM INDICATORS OF PERFORMANCE























Leading Indicators of Performance





















1. Enrollment Rate























































2a. Number of Initial Job Placements























































2b. Average Hourly Wage Rate at Placement























































2c. Number of Job Re-Placements























































2d. Average Hours Worked 1st Week of Placement























































3. Number Obtained High School Diploma or GED























































4. Number Obtained a Certificate























































5. Entered Post Secondary Education























































6. Entered Vocational/Occupational Skills Training























































7. Entered Pre-Apprenticeship























































8. Entered Registered Apprenticeship























































E. LONG-TERM INDICATORS OF PERFORMANCE























Common Performance Measures
























1. Placement in Education or Employment























































2. Attainment of a Degree Or Certificate























































3. Literacy and Numeracy Attainment























































Additional Performance Measures





















4. Recidivism Rate























































5. Retention Rate























































F. REPORT CERTIFICATION/ADDITIONAL COMMENTS





















Grantee Remarks:























































































Name of Grantee Certifying Official:


Telephone Number:

Email:

























































































This reporting requirement is approved under the Paperwork Reduction Act of 1995, OMB Control No. 1205-0464. Persons are not required to respond to this collection of information unless it displays a currently valid OMB number. Public reporting burden for this collection of information is estimated to average 16 hours per quarterly report per grantee, including time for reviewing instructions, searching existing data sources, gathering and reviewing the collection of information. Respondent’s obligation to reply is required to maintain benefits. The reason for the collection of information is general program oversight, evaluation and performance assessment. Send comments regarding this burden estimate or any other aspect of this collection, including suggestions for reducing this burden, to the U. S. Department of Labor, Employment and Training Administration, Youth Office, Room N4459, 200 Constitution Avenue, NW, Washington, D.C. 20210 (Paperwork Reduction Project 1205-0464).























































File Typeapplication/vnd.ms-excel
AuthorSmith, Jenn - ETA
Last Modified ByPena, Stephanie L - ETA
File Modified2020-10-23
File Created2004-12-26

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