0920-1276 Annual Reporting of the Rape Prevention and Education (R

CE19-1902: Rape Prevention & Education (RPE) Program: Using the Best Available Evidence for Sexual Violence Prevention

Annual Reporting of the Rape Prevention and Education (RPE) Program: CE19-1902 Cooperative Agreement

Work Plan Form
Recipients report on progress towards their work plan goals, objectives, and milestones. Recipients can add up to 3 additional goals (max 8 goals) and have no more than 5 objectives per
goal. You can add as many milestones to each objective as you’d like. Character limit counts include space.
CE19-1902 Required Goals and Objectives
Goal 1
Increase the use of partnerships to implement relationship/community-level strategies and improve coordination
of state SV prevention efforts
Objective 1.1
Develop an approach to improve partner coordination as specified in the State Action Plan
Objective 1.2
Implement an approach to improve partner coordination as specified in the State Action Plan
Goal 2
Increase use of data driven decision making for program delivery
Objective 2.1
Increase the use of data for selection of focus populations and prevention approaches
Objective 2.2
Demonstrate the selection of sub-recipients based on data-driven decision
Goal 3
Increase use of indicator data to track implementation and outcomes
Objective 3.1
Identify state-level indicators and data sources to include in the state evaluation plan
Objective 3.2
Track and report on indicators annually
Goal 4
Create environmental and community changes that result from selected community-level strategies
Objective 4.1
Develop plans for implementation for environmental and community-level prevention strategies
Goal 5
Demonstrate changes in selected risk and protective factors
Objective 5.1
Increase tracking of selected risk and protective factors
Objective 5.2
Implement state-level evaluation plan with process and outcome measures

Update the Objective Status (complete Comments on Objective if the status is Delayed or Discontinued) for each objective. Also update the Milestone Status for
each milestone (complete Comments on Objective if the status is Delayed or Discontinued) and select the Program Year Milestone Completed. If the activity is in
progress, select "Not Yet Complete."

CE19-1902: Rape Prevention & Education (RPE) Program: Using the Best Available Evidence for Sexual Violence Prevention

Goal #. Statement
Objective #. #
Text (Character Limit: 500)
Objective statement

Milestone
Description
Text (Character
Limit: 1000)
Milestone

Key Activities
Text (Character Limit:
1000)
Activities

Objective Status

Comments on Objective

Drop Down
☐ In Progress (On
track)
☐ Delayed
☐ Completed
☐ Discontinued
Milestone Status

Text (Character Limit:
500)
Comment on delayed or
discontinued work,
Conditionally Required

Drop Down
☐ In Progress (On
track)
☐ Delayed
☐ Completed
☐ Discontinued

Program Year Milestone
Completed
Drop Down
☐ Not Yet Complete
☐ Year 1
☐ Year 2
☐ Year 3

Milestone Comments
Text (Character Limit:
500)
Provide reasons for
delayed or discontinued
work, Conditionally
Required

Button to add row to Milestone table
Button to add objectives
Objective/Milestone
Status
Completed
On Track
Delayed
Discontinued

What progress did you make so far during the reporting on this item?
All work is completed.
Work is in progress and is on track.
Work has some delays.
Work has been stopped and discontinued.

Barriers, Facilitators, and Successes Form
SECTION: Barriers Encountered
Add all barriers encountered during the reporting period.
Did you experience barriers during this reporting period?
Drop Down
☐ No barriers encountered and then Save, Validate, and Check in.
☐ Yes, we experienced barriers (Record barriers in the table below)

Table: Barriers
If you experienced barriers during this reporting period, record those barriers in this table.
Each row should be a distinct barrier.

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CE19-1902: Rape Prevention & Education (RPE) Program: Using the Best Available Evidence for Sexual Violence Prevention
Barrier Type

Dropdown with other
Response
☐ Lack of Buy-in from
partners or stakeholders
☐ Insufficient funding or
resources
☐ Inability to access/collect
data
☐ Implementation issues
☐ Staffing issues (e.g.,
turnover)
☐ Inadequate training
☐ Evaluation Capacity
☐ COVID-19
☐ Other (not listed): specify
(Character Limit: 100)
Conditionally Required

Describe the barrier
and how it impacts
your program’s
work.
Text (Character
Limit: 2000)
Concisely describe
the barrier.
Describe how the
barrier has/may
affect your efforts.
In other words, how
will it affect your
efforts if actions
were not in place to
try to overcome it?
Conditionally
Required

Program Component

What actions were
taken or would be
helpful to address
the barrier?

Multiple responses
☐ Work Plan
☐ State Action Plan
☐ Prevention
Strategy
☐ Evaluation
☐ Partnership
☐ Training and TA
provided
Conditionally Required

Text (Character
Limit: 2000)
Describe what
action steps or
resolutions were
used or are planned
to overcome it.
Conditionally
Required

What resources
are used or would
be helpful to
address the
barrier?
Text (Character
Limit: 2000)
Describe
resources used or
needed to
overcome the
barrier.
Conditionally
Required

Barrier Comments

Text (Character
Limit: 500)
Optional

Button to add row to table

SECTION: Facilitators Encountered
Add all facilitators encountered during the reporting period.
Did you experience facilitators during this reporting period?
Drop Down
☐ No facilitators encountered and then Save, Validate, and Check in.
☐ Yes, we experienced facilitators (Record facilitators in the table below)

Table: Facilitators
If you experienced facilitators during this reporting period, record those facilitators in this table.
Each row should be a distinct facilitator.
Facilitator Type

Describe the facilitator and how
it impacts your work.

Annual Reporting for RPE Word Template

Program
Component

What resources
were used?

Facilitator Comments

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CE19-1902: Rape Prevention & Education (RPE) Program: Using the Best Available Evidence for Sexual Violence Prevention
Dropdown with other Response
☐ Strong partners/stakeholders
☐ Connection to community
☐ Access to funding or resources
☐ Access to data
☐ Strong implementation
☐ Adequate, experienced staff
☐ Access to training
☐ Other (not listed), specify:
(Character Limit: 100)
Conditionally Required

Text (Character Limit: 1000)
Concisely describe a facilitator
that supports and helps you
achieve and be successful.
Describe how this facilitator was
leveraged for your efforts, and
what would have happened if
you did not have this facilitator.
Conditionally Required

Multiple responses
with other
response
☐ Work Plan
☐ State Action
Plan
☐ Prevention
Strategy
☐ Evaluation
☐ Partnership
☐ Training and TA
provided
Conditionally
Required

Text (Character
Limit: 1000)
Conditionally
Required

Text (Character Limit:
500)
Optional

Button to add row to table

SECTION: Successes
Would you like to share any successes or accomplishments?
Drop Down
☐ No (Select Save, Validate, and Check in below).
☐ Yes (Record accomplishments in the table below)

Table: Successes and Accomplishments
Please describe your successes and accomplishments. Add a new row for each separate accomplishment.
What key accomplishments related to this NOFO has your state/territory/federal district achieved during this reporting period?
Text (Character limit: 6000)
Describe specific accomplishments and successes made during the reporting period.
Conditionally Required

Button to add row to table

Form: Continuation Narrative
Recipients are required to answer the following questions about plans and needs for the next budget year.

Summary of Work Plan Activities for Next Budget Year
Describe the activities planned for the upcoming budget period. Please include references and reasons for any key changes to the work plan for the upcoming budget period.
Text (Character Limit: 6000)

Implementation of Prevention Strategies
Describe the planned implementation of prevention strategies in the next budget period. Explain any requests to change the implementation of the current prevention strategies.
The CDC project officer must approve any changes to the prevention strategies.

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CE19-1902: Rape Prevention & Education (RPE) Program: Using the Best Available Evidence for Sexual Violence Prevention
Text (Character Limit: 8000)

Budgetary Implications
Provide any comments about budgetary issues that might impede the success or completion of the project as originally proposed and approved. Describe any implications the
changes to the work plan may have on the budget.
Text (Character Limit: 8000)

Needed Resources
Describe what additional tools or resources your program needs to accomplish the proposed planned activities for the next budget period.
Text (Character Limit: 8000)

Technical Assistance
What types of training and technical assistance do you need? Please describe the areas or topics for training and technical assistance, such as program or evaluation.
Text (Character Limit:8000)

Form: State Action Plan
Recipients report on their progress towards required components of the State Action Plan (e.g., enhancing partnership, data use, state sexual violence prevention
planning and coordination) during the reporting period.

SECTION: State Action Plan Progress
Were there changes to the State Action Plan during this reporting period?
Drop Down
☐ No (Continue to Progress on Priorities)
☐ Yes (Record changes in the table below)

Table: Changes to State Action Plan
Describe changes made to the State Action Plan during this reporting period. Each row is a distinct State Action Plan Component.
State Action Plan Required Components
Dropdown with Open Response
☐ Approach or Strategy
☐ Stakeholder/Partner
☐ State/local collaboration
☐ Resources/Funding
☐ Training/Technical Assistance
☐ Sustainability
☐ Health Disparities/Population of Interest
☐ Other (not listed): specify (Character Limit:
100)
Conditionally Required

Annual Reporting for RPE Word Template

Describe the change, the reason for the change, and how it impacts your program’s overarching work.
Text (Character Limit: 2000)
Conditionally Required

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CE19-1902: Rape Prevention & Education (RPE) Program: Using the Best Available Evidence for Sexual Violence Prevention
Button to add row to table

SECTION: Progress on Priorities
Report on progress toward the State Action Plan required priorities that happened during this reporting period. If no progress was made, respond with "No progress
this reporting period."
Addressing Health Disparities: Describe the key accomplishments made in this component. How did these accomplishments improve your program’s prevention efforts?
Text (Character Limit: 4000)
Capacity-Building Support to Unfunded Organizations: Describe the key accomplishments made in this component. How did these accomplishments improve your program’s
prevention efforts?
Text (Character Limit: 4000)
Evaluation and Data Use Capacity: Describe the key accomplishments made in this component. How did these accomplishments improve your program’s prevention efforts?
Text (Character Limit: 4000)
Public/Private Partnership: Describe the key accomplishments made in this component. How did these accomplishments improve your program’s prevention efforts?
Text (Character Limit: 4000)
Strategy Implementation: Describe the key accomplishments made in this component. How did these accomplishments improve your program’s prevention efforts?
Text (Character Limit: 4000)
Training/Technical Assistance: Describe the key accomplishments made in this component. How did these accomplishments improve your program’s prevention efforts?
Text (Character Limit: 4000)

SECTION: Partnership
Report on the partner status and funding during this reporting period. If there are changes in how the partner is engaged in the state/territory/federal district SV
prevention work, please make updates. Each item is a distinct partner.

Table: Partners
Name of the Organization
Text (Character Limit: 500) Provide the name of the partner organization.
If the organization is an implementing organization, make sure the name matches with the name provided in the Prevention Strategy Form.
Type of Organization
Sector
Special Focus/Emphasis of the Organization
Dropdown with Open Response
Dropdown with Open Response
Dropdown with Open Response
☐ Coalition, State
☐ Business/Labor
☐ Survivor serving
☐ Coalition, Local
☐ Education
☐ Tribal serving
☐ Community-based Organization
☐ Justice
☐ Culturally relevant
☐ College or University
☐ Health Services
☐ Youth serving
☐ For-Profit Organization (e.g., businesses)
☐ Housing
☐ LGBTQ serving
☐ Health care facility (e.g., health clinic, hospital)
☐ Media
☐ Military or Veteran serving

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CE19-1902: Rape Prevention & Education (RPE) Program: Using the Best Available Evidence for Sexual Violence Prevention
Name of the Organization
Text (Character Limit: 500) Provide the name of the partner organization.
If the organization is an implementing organization, make sure the name matches with the name provided in the Prevention Strategy Form.
☐ Local Health department
☐ Public Health
☐ Disability serving
☐ State Health department
☐ Social Services
☐ Research and/or evaluation
☐ Non-governmental organizations
☐ Government (Federal, State, County, Local)
☐ Community services and/or prevention
☐ Rape Crisis Center
☐ Community Organizations
☐ Healthcare or health services
☐ School
☐ Other (not listed): Specify (Character Limit: 100)
☐ Students and/or campus
☐ School District
☐ Children
☐ Other Local Government Agency
☐ None
☐ Other State Government Agency
☐ Other (not listed): Specify (Character Limit: 100)
☐ Other (not listed): Specify (Character Limit: 100)
Partner Status during this reporting period
Does your program
How is this partner engaged in the
Comments
provide RPE funding to
state/territory SV prevention work?
this partner during this
reporting period?
Drop Down
Drop Down
Text (Character Limit: 1000)
Text (Character Limit: 500)
Concisely describe how this partner is
Optional
☐ New, acquired during this reporting period
☐ Yes
engaged in the state sexual violence
Provide any additional information, if any not already
☐ Existing partner/stakeholder
☐ No
prevention efforts.
captured about the partner in this optional text field.
☐ Re-engaged partner/stakeholder
☐ Increased engagement
☐ No longer a partner/stakeholder

Button to add row to table

SECTION: Data Use
Report on data used during this reporting period. If the preloaded data has not been used during this reporting period, delete the row. If there is additional data to
report, add a row to the table.

Table: Data Use
What data have you used to select populations of focus, sub-recipients, select prevention strategies, and address health disparities during this reporting period?
What data has your program used
to…?

Data Source Type

Description of data source
obtained or used

Data Collector

Drop Down
☐ Select population of focus (Data
Driven Population of Focus)
☐ Select prevention strategies
(Data Driven Prevention Strategy)
☐ Select sub-recipients (Data
Driven Sub-Recipients)
☐ Address health disparities

Dropdown with Open
Response
☐ Needs Assessment
☐ Surveillance data
☐ Police data
☐ Hospital data
☐ Surveys

Text (Character Limit: 500)
Concisely describe the data
source that was used or
obtained during this reporting
period.

Text (Character Limit: 500)
Concisely describe who collects
the data or from where the data
were obtained.

Annual Reporting for RPE Word Template

Describe any barriers or challenges your
program encounter in accessing this data
source.
Text (Character Limit: 500)
Concisely describe any barriers or
challenges encountered in accessing this
data source.

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CE19-1902: Rape Prevention & Education (RPE) Program: Using the Best Available Evidence for Sexual Violence Prevention
What data has your program used
to…?

Data Source Type

Description of data source
obtained or used

Data Collector

Describe any barriers or challenges your
program encounter in accessing this data
source.

☐ Interviews
☐ Focus groups
☐ Administrative data
☐ Other (not listed): specify
(Character Limit: 100)

Button to add row to table

Form: Coalition Building
Recipients report on any of their coalition building efforts during the reporting period. Report on each coalition building effort that each implementing organization
implements.

SECTION: Description and Purpose
Were there any changes to the coalition building during this reporting period? If yes, please describe the changes that were made to the coalition building effort:
Drop Down
Text (Character Limit: 2000) Please describe the changes that were made to the coalition building effort.
☐ Yes, there were changes to the coalition building effort
☐ No, there were no changes to the coalition building effort

Coalition Building
What is the name of the coalition building effort?
Text (Character Limit: 200)
Provide a succinct yet informative name for this coalition building effort.

Description
Briefly describe the coalition building.
Text (Character Limit: 1000)
What is the purpose or role of the coalition building?
Dropdown with Open Response
☐ Collect and organize data
☐ Conduct needs assessments
☐ Train community members
☐ Leverage funds from sources other than RPE
☐ Leverage resources other than funding (e.g., personnel, space, supplies)
☐ Plan or implement prevention interventions
☐ Ensure that RPE-funded prevention interventions address issues related to cultural
competence
☐ Plan or implement process or outcome evaluations of prevention interventions

Annual Reporting for RPE Word Template

What are the goals of the coalition building?
Text (Character Limit: 2000)
Concisely describe the coalition building effort. What is intended to be accomplished by this
effort?

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CE19-1902: Rape Prevention & Education (RPE) Program: Using the Best Available Evidence for Sexual Violence Prevention
☐ Educate others about needed changes in policy at the organizational, local, or
state/tribal/jurisdiction level
☐ Implement community/societal strategies
☐ Other (not listed): Specify (Character Limit: 100)

SECTION: Implementation Progress
Report the number of activities completed during the reporting period (e.g., number of educational sessions delivered). Add any new activities.
Implementers
Provide a brief description who is involved in the coalition building effort.
Text (Character Limit: 500)
Concisely describe the implementers of the coalition building. Who is involved in ensuring the efforts are carried out?

Table: Activities
Update the number of activities completed during the reporting period. Add new and edit existing activities as needed.
To add, copy and paste the row. Each row should be a distinct activity type.
Activity Type
Description of Activity
Dropdown with Open Response
☐ Educational sessions
☐ Training sessions
☐ Projects
☐ Ads
☐ Web/Social Media Postings
☐ Text messages or emails
☐ Presentations
☐ Print materials
☐ Meetings
☐ Other (not listed): specify (Character
Limit: 100)

Text (Character Limit: 2000)
Concisely describe the activity
and how this demonstrates
progress on the coalition
building or community
mobilization implementation.

Purpose of Activity
Text (Character Limit: 2000)
Concisely describe how the
activity serves and relates to the
coalition building or community
mobilization effort.

Number of Activities Completed
(Update from Year 2 APR)
Integer:
Report on the number of activities
completed during the reporting
period (e.g., number of educational
sessions delivered).

Implementation Progress
Notes
Text (Character Limit: 500)
Optional
Any additional information
you would like us to know

Button to add row to table

Prevention Strategy Form
This form collects information about the prevention strategies and approaches being implemented, and their implementation measures and progress (e.g., reach,
delivery). Report on each program, policy, or practice that each implementing organization implements.

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CE19-1902: Rape Prevention & Education (RPE) Program: Using the Best Available Evidence for Sexual Violence Prevention

SECTION: Description
What is the status of this prevention strategy during this reporting period? If changes were made summarize them below:
Drop Down
Text (Character Limit: 2000) Summarize the changes to the prevention strategy.
☐ There are no changes to the prevention strategy (Select Save,
Validate, and Check in below)
☐ There are changes to the prevention strategy (Summarize the
changes and make updates below)
☐ This is a new prevention strategy

Description of Prevention Strategy
Only complete additional questions if you selected "Other (not listed)" as the prevention strategy.
Name of Program, Policy, or Practice
Dropdown with Open Response
☐ Adequate Work Supports
☐ Men of Strength Clubs
☐ Alcohol Policies
☐ Microfinance
☐ Bringing in the Bystander
☐ Powerful Voices
☐ Child Sexual Abuse program
☐ Proactive Sexual Harassment Prevention Policies and Procedures
☐ Coaching Boys into Men
☐ Real Consent
☐ Comparable Worth Policies
☐ Safe Dates
☐ Council for Boys and Young Men
☐ Safer Choices
☐ CPTED
☐ Second Step
☐ Dating Matters
☐ Shifting Boundaries Building-Level Intervention
☐ Enhanced Assess, Acknowledge, Act
☐ Strong African American Families – SAAF
☐ Expect Respect
☐ Other (not listed): specify (Character Limit: 100)
☐ Fourth R
☐ Girls Circle
☐ Green Dot
OTHER: Briefly describe the program, policy, or practice.
Text (Character Limit: 2000)
The description should explain clearly to someone who is not familiar with the prevention strategy: what the prevention strategy is, what it intends to do, how it is being implemented
locally or in your State/Territory, and where the prevention strategy will occur (the setting).
Conditionally Required
OTHER: Which STOP SV approach does this program, policy, or practice
OTHER: Explain how this program, policy, or practice aligns or addresses the STOP SV approach
address?
selected.
Dropdown with Open Response
Text (Character Limit: 2000)
Concisely explain how the program, policy, or practice aligns with or addresses the selected STOP SV
☐ Bystander approaches
approach. See the STOP SV technical package for description of the approaches for each STOP SV
☐ Mobilizing men and boys as allies
strategy.
☐ Social-emotional learning
Conditionally Required
☐ Teach healthy, safe dating and intimate relationship skills to adolescents
☐ Promoting healthy sexuality

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CE19-1902: Rape Prevention & Education (RPE) Program: Using the Best Available Evidence for Sexual Violence Prevention
☐ Empowerment-based training
☐ Strengthening economic supports for women and families
☐ Strengthening leadership and opportunities for girls
☐ Improving safety and monitoring in schools
☐ Establishing and consistently applying workplace policies
☐ Addressing community-level risks through environmental approaches
☐ Other (not listed): specify the STOP SV strategy with which this best aligns
(Character Limit: 100)
Conditionally Required

Delivery
Only complete the additional questions if you selected community mobilization or policy as the main method of delivery.
What is the main way this program, policy, or practice is delivered?
Dropdown
☐ Educational curriculum
☐ Social marketing
☐ Social media campaign
☐ Built environment change
☐ Organizational policy change (Complete questions below)
☐ Policy education or implementation (Complete questions below)
☐ Community mobilization (Complete questions below)
COMMUNITY MOBILIZATION OR POLICY: Please further describe the focus of the effort.
Text (Character Limit: 2000)
Conditionally Required
POLICY: Policy Type
Dropdown with Open Response
☐ Local ordinance
☐ Procedure
☐ Administrative action
☐ Incentive
☐ Organizational contract
☐ Rule/regulation
☐ Other (not listed): specify (Character Limit: 100)
Conditionally Required

Annual Reporting for RPE Word Template

POLICY: Policy Focus
Dropdown with Open Response
☐ Climate and safety
☐ Sexual harassment
☐ Alcohol
☐ Comparable worth/Pay equity
☐ Paid leave
☐ Housing
☐ Trauma informed
☐ Family friendly workplace
☐ Other (not listed): specify (Character Limit: 100)
Conditionally Required

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CE19-1902: Rape Prevention & Education (RPE) Program: Using the Best Available Evidence for Sexual Violence Prevention

Evidence of Effectiveness
Evidence of Effectiveness: Only complete this section if you selected "Other (not listed)" as the prevention strategy.
OTHER: What is the evidence for the effectiveness of the program, policy, or practice in addressing the identified sexual violence problem?
Evidence
OTHER: Describe the evidence of effectiveness
Dropdown with Open Response
Text (Character Limit: 2000)
Concisely describe the evidence (evaluations results, research outcomes, etc.) available for the effectiveness of the program,
☐ Based on best available research evidence
policy, or practice in addressing the identified sexual violence problem. What is the evidence to support that this strategy will
☐ Based on practice-based evidence
address the SV problem identified in the population of focus? The description and the selected category should align with
☐ Other (not listed): specify (Character Limit: 100)
each other.
Conditionally Required
Conditionally Required
OTHER: What are the reasons for selecting this prevention strategy?
Text (Character Limit: 2000) Concisely describe the reason for selecting this program, policy, or practice. What data led you to selecting it to address sexual violence problem in your
community?
Conditionally Required
OTHER, NOT POLICY: Describe the essential content, delivery, and implementer characteristics of this prevention strategy.
What – Describe the Essential Content
Text (Character Limit: 4000)
Conditionally Required
How – Describe the Essential Delivery
Text (Character Limit: 4000)
Conditionally Required
Who – Describe the Essential Implementer’s
Text (Character Limit: 4000)
Characteristics
Conditionally Required

SECTION: Population of Focus and Reach
Indicate whether changes were made to the population or setting of focus during the reporting period and if so, describe the changes. Complete the section on
Reach.
Were there any changes to the population and setting of focus during this reporting period? If yes, explain:
Drop Down
Text (Character Limit: 2000) If yes, explain
☐ Yes (Summarize changes and make updates below, including Reach)
☐ No (Complete Reach section below)

Population of Focus
Is there a specific community or population you are focusing on? (If the program, policy, or practice is focusing on a specific type of community or population, then select all
categories that apply. If it does not have a specific or special emphasis, then select no)
☐ No Specific Community or Population
☐ LGBTQ Communities
☐ Adolescent
☐ Other (not listed): specify (Character Limit: 100)
☐ Homeless
☐ African American or Black Population
☐ Other (not listed): specify (Character Limit: 100)
☐ Incarcerated or Formerly Incarcerated
☐ Asian Population
☐ Other (not listed): specify (Character Limit: 100)
☐ Migrant Workers
☐ Children and Families
☐ Other (not listed): specify (Character Limit: 100)
☐ Military

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CE19-1902: Rape Prevention & Education (RPE) Program: Using the Best Available Evidence for Sexual Violence Prevention
☐ Poor or Economically Disadvantaged
☐ Elder
☐ Other (not listed): specify (Character Limit: 100)
☐ People with Disabilities
☐ Foster Youths or Families
☐ Perpetrators of Crimes or Violence
☐ Hispanic or Latino Population
☐ Rural
☐ Immigrants or Refugees
☐ Tribal Communities
☐ Men and Boys
☐ Urban Communities
☐ Pacific Islanders Population
☐ Veterans
☐ Parents and Families
☐ Victims of Crimes or Violence
☐ Single Parents
☐ Vulnerable or At-Risk Population
☐ Women and Girls
Please indicate the types of individuals or organizations that you are focusing on and who you intend to affect.
Multiple responses with other response:
Types of Individuals
Types of Organizations
Types of Communities
☐ Students
☐ Schools or Universities
☐ School District
☐ Youths
☐ Governmental Agencies
☐ County
☐ Teachers/Professors
☐ Non-Government Agencies
☐ City
☐ School Administrators
☐ Non-Profits
☐ Census Tract/Zip Code
☐ School Staff
☐ Businesses
☐ Commercial District
☐ Policy Makers
☐ Bars
☐ Neighborhood
☐ Parents
☐ Homes
☐ Territory Area
☐ Healthcare Professionals
☐ Employers
☐ Park and Recreational Area
☐ Mental Health Providers
☐ Other (not listed): specify (Character Limit: 100)
☐ Other (not listed): specify (Character Limit: 100)
☐ Employees of an Organization
☐ Other (not listed): specify (Character Limit: 100)
☐ Other (not listed): specify (Character Limit: 100)
☐ Residents
☐ Other (not listed): specify (Character Limit: 100)
☐ Other (not listed): specify (Character Limit: 100)
☐ Other (not listed): specify (Character Limit: 100)
☐ Other (not listed): specify (Character Limit: 100)
☐ Other (not listed): specify (Character Limit: 100))
Why was this population or setting selected and how is the program, policy, or practice appropriate for the selected population or setting?
Text (Character Limit: 2000)
Concisely describe the reasons that the population and setting of focus was selected and the ways the selected program, policy, or practice are appropriate for them. What data led
you to selecting them? How is the selected program, policy, or practice appropriate for the selected population and setting?

Reach
Enter the number of individuals from the population of focus that were affected by or exposed to the prevention strategy. Individual reach should be reported for
all programs, policies, or practices.
Number of Individuals Reached
Integer: Enter the number of individuals from the population of focus affected by or exposed to the program, policy, or practice
Number of Schools Reached

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CE19-1902: Rape Prevention & Education (RPE) Program: Using the Best Available Evidence for Sexual Violence Prevention
Integer: Enter the number of Schools from the population of focus affected by or exposed to the program, policy, or practice
No data to report? Drop Down
☐ Data is missing (program unable to collect)
☐ Data is not applicable (program does not collect)
Number of Organizations Reached
Integer: Enter the number of organizations from the population of focus affected by or exposed to the program, policy, or practice
No data to report? Drop Down
☐ Data is missing (program unable to collect)
☐ Data is not applicable (program does not collect)
Number of Communities Reached
Integer: Enter the number of communities from the population of focus affected by or exposed to the program, policy, or practice
No data to report? Drop Down
☐ Data is missing (program unable to collect)
☐ Data is not applicable (program does not collect)

SECTION: Risk and Protective Factors and Violence Outcomes
Were there any changes to the risk and protective factors and violence outcomes during this reporting period? If yes, explain:
Drop Down
Text (Character Limit: 2000) If yes, explain
☐ Yes (Summarize changes and make updates below)
☐ No (Select Save, Validate, and Check in below)
Provide a narrative description of the outcomes and risk and protective factors that is the policy, program, or practice intend to change.
Text (Character Limit: 2000)
Concisely describe risk and protective factors that the program, policy, or practice intend to directly affect.
What risk and protective factors does this program, policy, or practice address?
Multiple responses with other response:
Individual Risk Factors
Relationship Risk Factors
Community Risk Factors

Annual Reporting for RPE Word Template

Societal Risk Factors

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CE19-1902: Rape Prevention & Education (RPE) Program: Using the Best Available Evidence for Sexual Violence Prevention
☐ Alcohol and drug use
☐ Delinquency
☐ Lack of empathy
☐ General aggressiveness and acceptance of
violence
☐ Early sexual initiation
☐ Coercive sexual fantasies
☐ Preference for impersonal sex and sexual risk
taking
☐ Exposure to sexually explicit media
☐ Hostility towards women
☐ Adherence to traditional gender role norms
☐ Hyper-masculinity
☐ Suicidal behavior
☐ Prior sexual victimization or perpetration
☐ Other (not listed): specify (Character Limit: 100)

☐ Family environment characterized by
physical violence and conflict
☐ Childhood history of physical, sexual,
or emotional abuse
☐ Emotionally unsupportive family
environment
☐ Poor parent-child relationships,
particularly with fathers
☐ Association with sexually aggressive,
hypermasculine, and delinquent peers
Involvement in a violent or abusive
intimate relationship
☐ Other (not listed): specify (Character
Limit: 100)

Individual Protective Factors
☐ Parental use of reasoning to resolve family
conflict
☐ Emotional health and connectedness
☐ Academic achievement
☐ Empathy and concern for how one’s actions
affect others
☐ Skills in solving problems non-violently
☐ Other (not listed): specify (Character Limit: 100)

Relationship Protective Factors
☐ Family support and connectedness
☐ Connection to a caring adult
☐ Association with pro-social peers
☐ Connection/commitment to school
☐ Other (not listed): specify (Character
Limit: 100)

☐ Poverty
☐ Lack of employment opportunities
☐ Lack of institutional support from
police and judicial system
☐ General tolerance of sexual violence
within the community
☐ Weak community sanctions against
sexual violence perpetrators
☐ High alcohol outlet density
☐ Diminished economic opportunities
☐ Poor neighborhood or community
support and cohesion
☐ Other (not listed): specify (Character
Limit: 100)

☐ Societal norms that support sexual
violence
☐ Societal norms that support male
superiority and sexual entitlement
☐ Societal norms that maintain women’s
inferiority and sexual submissiveness
☐ Weak laws and policies related to
sexual violence and gender equity
☐ High levels of crime and other forms of
violence
☐ Other (not listed): specify (Character
Limit: 100)

Community Protective Factors
Societal Protective Factors
☐ Neighborhood or Community
☐ Societal norms that violence is
support/connectedness
unacceptable
☐ Access to mental and health services
☐ Other (not listed): specify (Character
Limit: 100)
☐ Availability of safe and affordable
housing and the ability of families to
☐ Other (not listed): specify (Character
access housing assistance
Limit: 100)
☐ Other (not listed): specify (Character
Limit: 100)
☐ Other (not listed): specify (Character
Limit: 100)
How does this program, policy, or practice address those risk and protective factors among the population of focus?
Text (Character Limit: 2000)
Concisely describe how the program, policy, or practice addresses the selected risk and protective factors among the population of focus. How is the program, policy, or practice
appropriate for the sexual violence problem identified among the selected population and setting of focus?
What types of violence and injury outcomes does the program, policy, or practice directly address?
Multiple responses with other response:
☐ Sexual Violence
☐ Child Abuse and Neglect
☐ Child Sexual Abuse
☐ Human Trafficking
☐ Youth Violence
☐ Intimate Partner Violence
☐ Teen Dating Violence

Annual Reporting for RPE Word Template

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CE19-1902: Rape Prevention & Education (RPE) Program: Using the Best Available Evidence for Sexual Violence Prevention
☐ Suicide
☐ Other (not listed): specify (Character Limit: 100)

SECTION: Adaptation
What adaptations to the essential elements of the program, policy, or practice did you plan to make or have made during implementation?
Were there any changes to the adaptations during this reporting period? If yes, explain:
Drop Down
Text (Character Limit: 2000) Summarize the changes made to adaptations:
☐ Yes (Summarize changes and make updates below)
☐ No (Select Save, Validate, and Check in below)

Table: Adaptations
Adaptation Description
Text (Character Limit: 1000)
Concisely describe how the program, policy, or practice addresses the selected risk and protective factors among the population of focus. How is the program, policy, or practice
appropriate for the sexual violence problem identified among the selected population and setting of focus?
Conditionally Required
Which element of the program
Type of Adaptation
Reason for Adaptation
Describe the reason for this adaptation.
did you change or adapt?
Drop Down
Dropdown with Open Response
Drop Down
Text (Character Limit: 2000)
Concisely describe what led to this adaptation
☐ Content
☐ Added content
☐ To increase relevancy of material for
and how the adaptation was decided.
participants
☐ Design element
☐ Deleted content
Conditionally Required
☐ To increase participant participation
☐ Policy component
☐ Changed sequence of sessions
☐ To create or maintain relationships with
☐ Delivery or method
☐ Modified delivery or method
participants
☐ Implementer
☐Added policy component
☐ To respond to limited time and resources
Conditionally Required
☐ Deleted policy component
☐ To respond to a resource, space, or time
☐ Modified an environmental design element
limitation
☐ Changed the type of recommended
☐To increase relevancy to fit with context
implementer
☐ To align with the implementer’s facilitation
☐ Other (not listed): specify (Character Limit:
style
100)
☐ Other (not listed): specify (Character Limit:
Conditionally Required
100)
Conditionally Required
Was this adaptation made
What was the result or impact of the
Plan for this Adaptation in Future
Adaptation Notes
before or made during
adaptation?
Implementation Cycles
delivery?
Drop Down
Text (Character Limit: 2000)
Drop Down
Text (Character Limit: 500)
Optional
☐ Made before implementation How did the adaptation affect implementation
☐ Keep
or uptake of the program, policy, or practice?
started
☐ Change
☐ Made during implementation How did the adaptation affect its effectiveness?
☐ Omit
Conditionally Required
Conditionally Required
☐ Adapt across sites
☐ No plans

Annual Reporting for RPE Word Template

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CE19-1902: Rape Prevention & Education (RPE) Program: Using the Best Available Evidence for Sexual Violence Prevention
Conditionally Required

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How you plan to track and monitor these adaptations?
Text (Character Limit: 2000)
Describe how the adaptations will be tracked and monitored.
Conditionally Required

SECTION: Implementation Measures
Were there any changes to the implementation of this prevention strategy during this reporting period? If yes, explain:
Drop Down
Text (Character Limit: 2000) If yes, explain
☐ Yes (Summarize changes and make updates below)
☐ No (Update number of implementers and activities completed)
Provide a brief description about the implementers of this program, policy, or practice.
Text (Character Limit: 1000)
Concisely describe the implementers of the program, policy, or practice. Who is involved in ensuring the efforts are carried out?
How many implementers have been trained to deliver or implement the program, policy, or practice during Year #?
Integer: Provide the number of individuals who are the implementers during the reporting period.

Implementation Progress
Update the number of activities completed during the reporting period. Add new or edit existing activities as needed.

Table: Implementation Activities
To add, copy and paste the row. Each row should be a distinct activity type.
Activity Type
Dropdown with Open Response
☐ Educational sessions
☐ Training sessions
☐ Projects
☐ Ads
☐ Web/Social Media Postings
☐ Text messages or emails
☐ Presentations
☐ Print materials
☐ Meetings
☐ Other (not listed): specify (Character
Limit: 100)

Description of Activity
Text (Character Limit: 2000)
Concisely describe the activity
and how this demonstrates
progress on the coalition
building or community
mobilization implementation.

Purpose of Activity
Text (Character Limit:2000)
Concisely describe how the
activity serves and relates to the
coalition building or community
mobilization effort.

Number of Activities Completed
Integer:
Report on the number of activities
completed during the reporting
period.

Implementation
Comments
Text (Character Limit: 500)
Optional
Any additional information
you would like us to know

Button to add row to table
Annual Reporting for RPE Word Template

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CE19-1902: Rape Prevention & Education (RPE) Program: Using the Best Available Evidence for Sexual Violence Prevention

SECTION: Resources
Were there any changes to your resources for this program, policy, or practice during this reporting period? If yes, explain:
Drop Down
Text (Character Limit: 1000) If yes, explain
☐ Yes (Summarize the changes)
☐ No (Select Save, Validate, and Check in below)
How much of this program, policy, or practice was funded by RPE?
Drop Down
☐ Fully funded by RPE
☐ Funded in part by RPE

Form: Evaluation
Recipients report on their progress on evaluation activities and on indicators measuring the outcomes of their efforts for CE19-1902.

SECTION: Evaluation Plan
Changes to Evaluation Plan
Were there any changes to the evaluation plan during this reporting period?
Drop Down
☐ Yes (Complete table below)
☐ No (Select Save, Validate, and Check in below)

Table: Changes to Evaluation Plan
Describe the change, the reason for the change, and how it impacts your overall work.
Evaluation Plan Change

Describe the Change

Reason for the Change

Dropdown with Open Response
☐ Evaluation Design
☐ Evaluation Question
☐ Data Analysis, Synthesis, and Interpretation
☐ Data Collection Method or Data Source
☐ Measures and Indicators
☐ Translation, Communication, and Dissemination
☐ Evaluation Team
☐ Other (not listed): specify (Character Limit: 100)
Conditionally Required

Text (Character Limit: 2000)
Concisely describe the change
Conditionally Required

Text (Character Limit: 2000)
Concisely describe the reason for the
change
Conditionally Required

How does this change impact your
overall work?
Text (Character Limit: 500)
Provide any additional information
about this change that has not yet been
captured.
Conditionally Required

Button to add row to table
Annual Reporting for RPE Word Template

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CE19-1902: Rape Prevention & Education (RPE) Program: Using the Best Available Evidence for Sexual Violence Prevention

Analysis, Interpretation, and Synthesis
Please describe your approach to analyzing and summarizing your evaluation data including: primary focus of your analysis; methods used to analyze data; staff and consultants
who will work on analysis; and how you plan to report findings to stakeholders. How will evaluation data be analyzed, synthesized, interpreted?
Text Area (Character Limit:6000)
Optional
Please describe your progress on analysis, interpretation, and synthesis during this reporting period
Text Area (Character Limit: 5000)
Optional

Continuous Quality Improvement (CQI)
Describe the change, the reason for the change, and how it impacts your overall work.
Describe the process and plan for evaluation findings and how data will be used for CQI.
Text Area (Character Limit: 2000)
Optional
Describe the process for engaging and promoting CQI among sub-recipients.
Text Area (Character Limit: 1000)
Optional
Describe methods for CQI and how lessons learned will be shared with sub-recipients.
Text Area (Character Limit: 1000)
Optional
Please describe your program’s progress on CQI and facilitating use of data.
Text Area (Character Limit: 2000)
Optional

SECTION: Progress on Addressing Evaluation Questions
Table: Evaluation Questions
Rows for each Evaluation Question are Prefilled for the recipients. They are then able to add extra rows with Other evaluation questions if the want to.
Evaluation Question
Drop Down

Annual Reporting for RPE Word Template

What progress have you made on this evaluation question?
(e.g., data collected to date)
Text Area (Character Limit: 5000)

Notes
Text Area (Character Limit: 1000)

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CE19-1902: Rape Prevention & Education (RPE) Program: Using the Best Available Evidence for Sexual Violence Prevention
☐ Q1 Partnership: To what extent has the state built
or enhanced partnerships for SV prevention?
☐ Q2 Data Use: To what extent has the recipient
used data to select and prioritize the subrecipients, the prevention strategies and
approaches and the population of focus?
☐ Q3 Risk and Protective Factors: To what extent
have targeted risk and protective factors for SV
outcomes changed at the state level?
☐ Q4 Implementation: To what extent have
selected prevention strategies been implemented
in the state?
☐ Q5 Contextual Factors: Which factors are critical
for implementing selected prevention strategies
and approached?
☐ Q6 Alignment: To what extent are sub-recipient
activities aligned with state level goals and
outcomes stated in the state action plan and
recipient work plan?
☐ Other (not listed): specify (Character Limit: 250)
Optional

Optional

Optional

Button to add row to table

SECTION: Indicators
Table: Risk and Protective Factors & Violence Outcomes
Description
of Outcome

Risk and Protective Factor Category

Annual Reporting for RPE Word Template

Indicators

Data Sources

Summary of Trends for the
Outcome

Outcome Notes

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CE19-1902: Rape Prevention & Education (RPE) Program: Using the Best Available Evidence for Sexual Violence Prevention
Text Area
(Character
Limit: 2000)
Optional

Drop Down
☐ Knowledge, Skills, Attitudes
☐ Behavior Change
☐ Awareness
☐ Caring Adults Connectedness
☐ Community Connectedness
☐ Economic stability
☐ Equitable Access
☐ Family Connectedness
☐ Financial supports
☐ Gender Norms
☐ Neighborhood Environments
☐ Organizational
Climate/environment
☐ Policies or procedures
☐ Prosocial Peer Connectedness
☐ School Connectedness
☐ School environment/climate
☐ Social Norms
☐ Violence Victimization
☐ Violence Perpetration
☐ Other (not listed): specify
(Character Limit: 100)
Optional

Text Area
(Character
Limit: 5000)
Optional

Text Area
(Character
Limit: 5000)
Optional

Text Area (Character Limit: 6000)
Optional

Text Area (Character Limit: 1000)
Optional

Button to add row to table

Table: Other Outcomes
Description of
Outcome
Text Area
(Character
Limit: 2000)
Optional

Indicators

Data Sources

Text Area
(Character Limit:
5000)
Optional

Text Area
(Character Limit:
5000)
Optional

Annual Reporting for RPE Word Template

Summary of Trends for the
Outcome
Text Area (Character Limit: 6000)
Optional

Outcome Notes
Text Area (Character Limit: 1000)
Optional

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CE19-1902: Rape Prevention & Education (RPE) Program: Using the Best Available Evidence for Sexual Violence Prevention
Button to add row to table

SECTION: Translation, Communication, Dissemination
Describe your approach to how you will translate evaluation findings into actionable and useful information, disseminate lessons learned, and facilitate use of data to advance
program among recipients and sub-recipients and to advance the field. This may include considering your key audiences, types of products, and strategies used to communicate
and disseminate them.
Text Area (Character Limit: 6000)
Optional

Table: Products
Describe your progress on your translation, communication, and dissemination efforts and their impact or contribution to your state’s prevention efforts.
Description of
Product

Product Type

Text Area
(Character Limit:
2000)
Optional

Checkbox with Open
Response
☐ Brief (e.g., Fact Sheet)
☐ Communities of Practice
☐ Conference
☐ Email
☐ Manuscript/Scientific
Publication
☐ Mass Media Campaign
☐ Meeting
☐ Newsletter
☐ Report
☐ Resource Guide
☐ Social Media
☐ Workshop/Training
☐ Webinar
☐ Press Release
☐ Other (not listed): specify
(Character Limit: 100)
Optional

How will you
use this product
in your work?
Text Area
(Character Limit:
2000)
Optional

Primary
Audience

Audience Type

Impact &
Contribution

To how many are you disseminating?

Text Area
(Character
Limit: 2000)
Optional

Checkbox with
Open Response
☐ Funders
☐ General Public
☐ Implementers
☐ Local/State
Government
☐ News/Press
☐ Participants
☐ Partners
☐ Policymakers
☐ Sexual Violence
Field
☐ Other (not listed):
specify (Character
Limit: 100)
Optional

Text Area
(Character Limit:
5000)
Optional

Integer OR
No data to
report? Drop
Down
☐ Data is
missing
(program
unable to
collect)
☐ Data is not
applicable
(program
does not
collect)
Optional

Unit
Drop Down
☐ Individuals
☐ Organizations
Optional

Button to add row to table

Annual Reporting for RPE Word Template

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