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Juvenile Mentoring Subgrantee Reporting Form

Juvenile Mentoring Subgrantee Reporting Form

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Published by mpriceatccusa
The paper form that corresponds with the on-line form of the OJJDP DCTAT. There are measures that have been redacted because they do not relate to the CCUSA National Mentoring Program.
The paper form that corresponds with the on-line form of the OJJDP DCTAT. There are measures that have been redacted because they do not relate to the CCUSA National Mentoring Program.

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Published by: mpriceatccusa on Jun 19, 2013
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07/09/2013

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OFFICE OF JUVENILE JUSTICE AND DELINQUENCY PREVENTIONJUVENILE MENTORING GRANT PROGRAM
1
DCTAT SUBGRANTEE DATA COLLECTION FORM
Reporting Period: ________________________ 
 
This document is for your use to assist with gathering information that should be reported into the DCTAT tool.It is not necessary to submit this form to OJJDP. It is only for your information.
Award Information
Solicitation:
(Prepopulated)
 
Federal award number:
(Prepopulated)
  Award Period Start Date:
(Prepopulated)
 
(mm/dd/yyyy)
  Award Period End Date:
(Prepopulated)
 
(mm/dd/yyyy)
 1. Please enter the total amount of grant (Federal Funds Only): $
*Any funds reported only represent an estimate of dollars allocated or used for activities covered by this grant award.
 2. Was there grant activity during the reporting period?
 ___ 
Yes ___ No
 
Grant activity is defined as proposed activities in the OJJDP-approved grant application that are implemented or executed with theOJJDP grant.
 3. Please enter the Federal Congressional District(s) of where services are provided: ___________________ 
Check boxes will appear in the system, where you will select your state/territory and Federal Congressional District(s).Click http://www.house.gov, to use the zip code(s) of the area(s) served by the project to determine the Federal CongressionalDistrict(s).
 4. Please enter the Project Title:a. Please enter the Project Description:5. Please enter the Implementing Organization Name:6. Please select the implementing organization type:
 ___ Coalition ___ Juvenile Justice ___ Non-profit community-based organization ___ Other community-based organization ___ Other government agency ___ Police/other law enforcement ___ School/Other Education ___ Tribal Government ___ Unit of local government
7. Is this award used to implement evidence-based programs?
___ 
Yes ___ No8. If yes, select one source from which the program model was cited:
 ___ Blueprints for Violence Prevention ___ CASEL (Collaborative for Academic, Social, &Emotional learning) ___ Centers for Disease Control and Prevention ___ Community Guide to Helping America’s Youth ___ Department of Education Safe, Disciplined, &Drug-free Schools ___ Drug Strategies, Inc. ___ Making the Grade ___ Hamilton Fish Institute ___ Institute for Medicine ___ NIDA Preventing Drug Abuse ___ National Institute of Justice What Works Report ___ OJJDP Model Programs Guide ___ Promising Practices Network ___ SAMSHA Model Programs ___ Surgeon General’s Youth Violence Report ___ Other (e.g., State model program resources)
9. If other, please specify:
 
OFFICE OF JUVENILE JUSTICE AND DELINQUENCY PREVENTIONJUVENILE MENTORING GRANT PROGRAM
2
Target Population for this Subaward
Please check the appropriate boxes to indicate for this subaward:1. The population actually served during the project period; and2. The populations, if any, to which the program offers targeted services.Targeted services include any services or approaches specifically designed to meet the needs of thepopulation (e.g., gender specific, culturally based, developmentally appropriate services).
Population1. Did you serve thisgroup during thereporting period?2. Did this subgrantprovide targetedservices for any of thefollowing groups?
   R   A   C   E   /   E   T   H   N   I   C   I   T   Y
 American Indian/Alaskan Native AsianBlack/African AmericanHispanic or Latino (of any race)Native Hawaiian and Other Pacific Islander Other RaceWhite/CaucasianYouth population not directly served ___  ___  ___  ___  ___  ___  ___  ___  ___  ___  ___  ___  ___  ___  ___  ___ 
   J   U   S   T   I   C   E
 At-Risk Population (no prior offense)First Time OffendersRepeat OffendersSex OffendersStatus OffendersViolent OffendersYouth population not directly served ___  ___  ___  ___  ___  ___  ___  ___  ___  ___  ___  ___  ___  ___ 
   G   E   N   D   E   R
MaleFemaleYouth population not directly served ___  ___  ___  ___  ___  ___ 
   A   G   E
0-1011-18Over 18Youth population not directly served ___  ___  ___  ___  ___  ___  ___  ___ 
   G   E   O 
RuralSuburbanTribalUrbanYouth population not directly served ___  ___  ___  ___  ___  ___  ___  ___  ___  ___ 
   O   T   H   E   R
Mental HealthSubstance AbuseTruant/Dropout ___  ___  ___  ___  ___  ___ 
 
OFFICE OF JUVENILE JUSTICE AND DELINQUENCY PREVENTIONJUVENILE MENTORING GRANT PROGRAM
Bold indicates mandatory indicators.
3
 
Performance Measures
Output Measure Definition Data Grantee Provides Record Data Here
1
Number and percent of youth with whom anevidence-based practice wasused
The number and percent of youth with whom anevidence-based practice was used. Evidence-based practice models include program modelsthat have been shown, through rigorousevaluation and replication, to be effective atpreventing or reducing juvenile delinquency or related risk factors, such as substance abuse.Model programs can come from many valid
sources (e.g., Blueprints, OJJDP‟s ModelPrograms Guide, SAMHSA‟s Model Programs,
state model program resources, etc.) A. The number of youth served using anevidence-based model or programB. The number of youth servedC. Percent (A/B)2
Increase in number of program mentors recruited
The number of new mentors recruited during the
reporting period. “Recruited” mentors are those
who have completed requirements to be ready for training.Program records are the preferred data source. A. The increase in number of program mentorsrecruited (ready for training) during thereporting period3
Number and percent of program mentorssuccessfully completingtraining
The number and percent of program mentorssuccessfully completing training during thereporting period.Program records are the preferred data source. A.
 
Number of program mentors successfullycompleting training during the reporting periodB.
 
Total number of program mentors who begantraining during the reporting periodC.
 
Percent (A/B)4
Number and percent of trained program mentorswith increased knowledge of the program area
The number of trained program mentorsdemonstrating increased knowledge of theprogram during the reporting period.Program records are the preferred data source. A. Number of trained program mentorsdemonstrating increased knowledge of theprogram during the reporting periodB. Number of trained program mentors (Auto fillfrom 3A)C. Percent (A/B)5
Mentor Retention
The number of program mentors retained by theprogram within the reporting period.Program records are the preferred data source. A. Number of mentors who have left the programduring the reporting periodB. The total number of mentors in the programduring the reporting periodC. (B
 –
A)/B = Mentor Retention Rate6
Increase in youth enrolledsince the beginning of thegrant program
Increase in the number of youth enrolled (beingmentored) since the beginning of the grantprogram. A. Number of youth enrolled at the beginning of the reporting periodB. Number of NEW youth added during thereporting period

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