| PERSONS LIVING WITH DEMENTIA AND CAREGIVERS SERVED - Cumulative from grant start date |
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| Grantee name |
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| Grant ID |
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| Reporting period (start date - end date) |
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| Report submission date |
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| NUMBERS MUST BE ENTERED FOR ALL DEMOGRAPHIC CATEGORIES |
|
| Demographic category |
Persons living with dementia |
Caregivers |
Total |
|
| TOTAL SERVED - Cumulative and unduplicated from grant start date |
|
|
0 |
|
| Age |
|
|
|
|
| Under 60 |
|
|
0 |
|
| 60+ |
|
|
0 |
|
| Age missing |
|
|
0 |
|
| Gender identity |
|
|
|
|
| Woman |
|
|
0 |
|
| Man |
|
|
0 |
|
| Non-binary |
|
|
0 |
|
| Use a different term |
|
|
0 |
|
| Prefer not to answer |
|
|
0 |
|
| Gender missing |
|
|
0 |
|
| Transgender |
|
|
|
|
| Yes |
|
|
0 |
|
| No |
|
|
0 |
|
| Prefer not to answer |
|
|
0 |
|
| Transgender missing |
|
|
0 |
|
| Sexual orientation |
|
|
0 |
|
| Lesbian or gay |
|
|
0 |
|
| Straight, that is, not gay or lesbian |
|
|
0 |
|
| Bisexual |
|
|
0 |
|
| Use a different term |
|
|
0 |
|
| Don't know |
|
|
0 |
|
| Prefer not to answer |
|
|
0 |
|
| Sexual orientation missing |
|
|
0 |
|
| Geographic location |
|
|
|
|
| Urban |
|
|
0 |
|
| Rural |
|
|
0 |
|
| Geographic location missing |
|
|
0 |
|
| Ethnicity |
|
|
|
|
| Hispanic or Latino |
|
|
0 |
|
| Not Hispanic or Latino |
|
|
0 |
|
| Ethnicity missing |
|
|
0 |
|
| Race* |
|
|
|
|
| American Indian or Alaskan Native |
|
|
0 |
|
| Asian or Asian American |
|
|
0 |
|
| Black or African American |
|
|
0 |
|
| Middle Eastern North African (MENA) |
|
|
0 |
|
| Native Hawaiian or other Pacific Islander |
|
|
0 |
|
| White |
|
|
0 |
|
| Some other race |
|
|
0 |
|
| Race missing |
|
|
0 |
|
| Minority status |
|
|
|
|
| Minority |
|
|
0 |
|
| Not minority |
|
|
0 |
|
| Minority status missing |
|
|
0 |
|
| Intellectual & developmental disability |
|
|
|
|
| Persons with IDD |
|
|
0 |
|
| Persons without IDD |
|
|
0 |
|
| IDD status missing |
|
|
0 |
|
| Military status |
|
|
|
|
| Served in the military |
|
|
0 |
|
| Has not served in the military |
|
|
0 |
|
| Military status missing |
|
|
0 |
|
| Relationship to caregiver |
|
|
|
|
| Spouse or partner |
|
|
0 |
|
| Parent |
|
|
0 |
|
| Other caregiver |
|
|
0 |
|
| No caregiver |
|
|
0 |
|
| Relationship Missing |
|
|
0 |
|
| Living arrangement |
|
|
|
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| Lives alone, has an identified caregiver |
|
|
0 |
|
| Lives alone, no identified caregiver |
|
|
0 |
|
| Lives with a caregiver |
|
|
0 |
|
| Lives with someone who is not a caregiver |
|
|
0 |
|
| Living arrangement missing |
|
|
0 |
|
| *Participants may check more than one race, so the total for the Race category may be greater than the total in line 9. |
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| For questions about categories and definitions, see the 2023 OMB Definitions and FAQs document or contact your Resource Center staff person. |
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PROFESSIONALS TRAINED, BY FUNCTION
Cumulative and unduplicated from grant start date |
Number of professionals trained |
| Any IDD providers (e.g., case managers, group homes, direct care, state or county agencies) |
|
| Information and referral providers, options counselors |
|
| Case managers, care coordinators, discharge planners |
|
| Other dementia-related program providers (e.g., caregiver skills trainers, support group facilitators, adult day services staff) |
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| Direct care workers (e.g., certified nursing assistants, personal care attendants, companions) |
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| Medical care providers (e.g., physicians, nurse practitioners, physicians assistants) |
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| Allied health providers (e.g., occupational therapists, pharmacists, dietitians) |
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| Volunteers (e.g., Meals on Wheels, friendly visitors) |
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| First responders (paid and unpaid) |
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| Legal professionals |
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| Financial professionals (e.g., bank tellers, financial planners) |
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| Community businesses (e.g., retail store employees, café baristas, hairdressers) |
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| Clergy, other members of faith community |
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| Students preparing for dementia-related work |
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| Other |
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| Profession missing |
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| TOTAL TRAINED |
0 |
| Training data should not include outreach and awareness activities. |
| Total trained should not include persons living with dementia, caregivers, or the general public. |
| For questions about categories and definitions, see the 2023 OMB Definitions and FAQs document or contact your Resource Center staff person. |
| SERVICES & EXPENDITURES - Cumulative from grant start date |
|
| Units of Direct Service Delivered |
|
| Persons living with dementia, caregivers and other consumers |
|
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| Professionals |
|
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| Total Units of Direct Service Delivered |
0 |
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| Percentage of Cumulative Grant Funds (Federal and Match) Spent on: |
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| Direct Service Expenses |
|
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| Administrative Expenses |
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| Other Programmatic Expenses |
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| If your project is not meeting direct service and/or expenditure requirements by the end of this reporting period (reflected in the numbers above), please describe -- in the box to the right -- why the project has not met these requirements and confirm that the project will meet these requirements by the end of the grant. Information on expenditure requirements can be found in the Notice of Award. |
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| For questions about categories and definitions, see the 2023 OMB Definitions and FAQs document or contact your Resource Center staff person. |
|