Peace Corps Volunteer Report

Country: Name of Project:

VID #: Peace Corps Volunteer Name:

This report covers activity in which fiscal year (Oct 1 - Sep 30)? Trimester 1: Oct, Nov, Dec, Jan Trimester 2: Feb, Mar, Apr, May Trimester 3: June, July, Aug, Sept

Hyperlinks to report worksheets
Tell your story (community integration, lessons learned, etc) Activity tracking sheet Mass media activities Counterpart Feedback Volunteer and APCD feedback Other information

Trimester

Worksheets to be filled out once per year at end of fiscal year
Total participants (only report once at end of year) Agency initiative area summary (only report once at end of year)

Appendices to this reporting tool
Project framework (purpose, goals, objectives) Definitions Questions to help measure outcomes

COMMUNITY INTEGRATION:
How integrated do you feel in your community? (Place an X in the box that best represents how integrated you felt during the period.)
Not integrated Somewhat integrated Integrated Well integrated Gone native

Please provide more detail about your community integration (How is your language learning going? What have you learned about cross-cultural integration? Do you have any suggestions for training based on your community integration experiences?)

VOLUNTEER SUCCESS STORY!
Please provide a short (2-3 paragraph) description of your work in meeting the goals of this project, or describe a 'secondary' activity. In writing, try to show the positive difference you and your counterparts have made in your community. (If you are completing this manually, attach extra sheets as needed.)

CHALLENGES: What challenges have you faced in your project or in other areas of your Peace Corps experience?

LESSONS LEARNED: Describe lessons learned about your project, your community or yourself.

ACTIVITIES PLANNED FOR NEXT 3 TO 4 MONTHS:

PEACE CORPS GOAL TWO: " to help promote a better understanding of the American people on the part of the
peoples served…" If you have done something with your community to promote a better understanding of Americans--of your own cultural heritage, of American ideals you care passionately about, etc--please describe below what you did.

PEACE CORPS GOAL THREE: " to help promote a better understanding of other peoples on the part of the
American people." If you have done something to promote more understanding back home about aspects of life in your community here, please describe below what you did.

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SAFETY/SECURITY
How safe to you feel at home and at work? (Place an X in the box that best represents how safe you felt during the period.)
Always feel safe Occassionally feel unsafe Often feel unsafe

Please provide more detail about your safety and security concerns, if any:

COMMUNITY PARTNERS
Please provide information on new community partners you worked with during this reporting period. You don't have to list the same partners you've reported previously. The purpose of this section is to help provide us with a fuller understanding of the organizations present in your community, to help us build a better profile of the community over time, and to help us understand who the resources are that future Volunteers might want to link with. Name Title/Organization Contact Information Area of Cooperation

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Brief description of the activity (What did you do? What was the purpose of the activity? Who participated in the activity? What's the name of the group?)

Output of activity (What was the short-term output of the activity? E.g. a new strategic plan for an organization; a revised curriculum for teachers)

Select the project objective number Number of or 'secondary org's activity' from the drop down list

Number of communities

Individual Individual men (25 and women (25
older) and older)

Individual Individual boys girls (15-24) (15-24)

Brief description of the activity (What Individual did you do? What was the purpose of the boys activity? Who participated in the activity? (under 15) What's the name of the group?)

Individual girls (under 15)

Service Provider men

Service provider women

Service Provider boys (15-24)

Service Provider girls (15-24)

Service Provider boys (under 15)

Service If the activity had an HIV-AIDS focus, select Provider from the drop-down list the indicator that girls best applies. (under 15)

Brief description of the activity (What did you do? What was the purpose of the activity? Who participated in the activity? What's the name of the group?)

Output of activity (What was the short-term output of the activity? E.g. a new strategic plan for an organization; a revised curriculum for teachers)

Select the project objective number Number of or 'secondary org's activity' from the drop down list

Number of communities

Individual Individual men (25 and women (25
older) and older)

Individual Individual boys girls (15-24) (15-24)

Brief description of the activity (What Individual did you do? What was the purpose of the boys activity? Who participated in the activity? (under 15) What's the name of the group?)

Individual girls (under 15)

Service Provider men

Service provider women

Service Provider boys (15-24)

Service Provider girls (15-24)

Service Provider boys (under 15)

Service If the activity had an HIV-AIDS focus, select Provider from the drop-down list the indicator that girls best applies. (under 15)

Brief description of the activity (What did you do? What was the purpose of the activity? Who participated in the activity? What's the name of the group?)

Output of activity (What was the short-term output of the activity? E.g. a new strategic plan for an organization; a revised curriculum for teachers)

Select the project objective number Number of or 'secondary org's activity' from the drop down list

Number of communities

Individual Individual men (25 and women (25
older) and older)

Individual Individual boys girls (15-24) (15-24)

Brief description of the activity (What Individual did you do? What was the purpose of the boys activity? Who participated in the activity? (under 15) What's the name of the group?)

Individual girls (under 15)

Service Provider men

Service provider women

Service Provider boys (15-24)

Service Provider girls (15-24)

Service Provider boys (under 15)

Service If the activity had an HIV-AIDS focus, select Provider from the drop-down list the indicator that girls best applies. (under 15)

Go to Main Menu Outcome indicators (These indicators describe participant outcomes we are trying to achieve in this project. They are intended to ease recording of key changes you have observed or measured in the knowledge, skills, attitudes, behaviors, or condition of project participants.)

Go to project framework
Select the project objective number from the drop down list

Go to Activity Tracking Sheet

Baseline Data

Total within the fiscal year (Oct 1 to Sept 30)

Change

0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0

Go to Main Menu Outcome indicators (These indicators describe participant outcomes we are trying to achieve in this project. They are intended to ease recording of key changes you have observed or measured in the knowledge, skills, attitudes, behaviors, or condition of project participants.)

Go to project framework
Select the project objective number from the drop down list

Go to Activity Tracking Sheet

Baseline Data

Total within the fiscal year (Oct 1 to Sept 30)

Change

0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0

Go to Main Menu Outcome indicators (These indicators describe participant outcomes we are trying to achieve in this project. They are intended to ease recording of key changes you have observed or measured in the knowledge, skills, attitudes, behaviors, or condition of project participants.)

Go to project framework
Select the project objective number from the drop down list

Go to Activity Tracking Sheet

Baseline Data

Total within the fiscal year (Oct 1 to Sept 30)

Change

0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0

Go to Main Menu Outcome indicators (These indicators describe participant outcomes we are trying to achieve in this project. They are intended to ease recording of key changes you have observed or measured in the knowledge, skills, attitudes, behaviors, or condition of project participants.)

Go to project framework
Select the project objective number from the drop down list

Go to Activity Tracking Sheet

Baseline Data

Total within the fiscal year (Oct 1 to Sept 30)

Change

0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0

Go to Main Menu Outcome indicators (These indicators describe participant outcomes we are trying to achieve in this project. They are intended to ease recording of key changes you have observed or measured in the knowledge, skills, attitudes, behaviors, or condition of project participants.)

Go to project framework
Select the project objective number from the drop down list

Go to Activity Tracking Sheet

Baseline Data

Total within the fiscal year (Oct 1 to Sept 30)

Change

0 0 0 0 0 0

Go to Main Menu

Go to Activity Tracking Sheet

Mass media activities or other events where attendance was too large to count

Report your best estimate of the total number of individuals reached through mass media activities or events where attendance was too large to count. These events could include radio broadcasts, public theatre, printed materials distributed at a market, a television broadcast, etc. If you did not conduct any mass media activities, leave this section blank.

Description of mass media activity or event (please note in your description the project objective number that this activity supported, if applicable)

Estimated number of individuals reached

If it was an HIV/AIDS Who is your contact person for this kind activity, select 'yes' of mass media activity? Please include contact information (phone, e-mail)

Community Partner Feedback Please tell us what is going well in your collaboration with your PCV, as well as any concerns or challenges you may be having.

Community Partner Signature Supervisor Feedback Please review this report and write your feedback below.

Date

Supervisor Signature

Date

PCV Feedback to Peace Corps Please use this space for anything you would like to request / discuss / share with your APCD at this time. This section is not intended to be shared with your counterpart or supervisor.

PCV Signature

Date

APCD FEEDBACK to Volunteer Please provide feedback to volunteer based on each section of the report.

APCD Signature

Date

Go to Main Menu

Other Information

Other 1

Please use this space to raise any questions/concerns or suggestions for the CD or PTO.

Other 2

Please indicate if your health has impacted your ability to do your job during the reporting period.

Other 3

If any national issues have impacted your service thie period, please describe them here.

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Go to Main Menu

Total Fiscal Year Project Participants

COMPLETE THIS WORKSHEET JUST ONCE PER YEAR AS PART OF FOR YOUR FINAL REPORT OF THE FISCAL YEAR (from October 1 through September 30).
As part of your final report on the fiscal year just ended (Oct 1 through Sept 30), please enter below the total number of project participants you worked with over the year. To avoid counting the same person, organization or community more than once, refer to your 'individual activity tracking book' and tally up all the 'first-time' participants within the fiscal year. Please do not include estimates of indirect beneficiaires, or of individuals reached through mass media activities. The numbers below are supposed to include all the people, organizations, and communities you reached with direct, capacity-building kinds of activities. Number of participating individuals and service providers Men Individuals Service providers Women Boys Girls under 25 under 25 Number of participating organizations and communities
Organizations Communities

Go to Main Menu

Please describe your work during the past fiscal year go to HIV/AIDS in Peace Corps' 4 "Initiative" areas: HIV, ICT, WID/GAD, and Youth

go to ICT

go to WID/GAD

go to Youth

COMPLETE THIS WORKSHEET JUST ONCE PER YEAR AS PART OF FOR YOUR FINAL REPORT OF THE FISCAL YEAR (from October 1 through September 30). 1. HIV/AIDS Prevention and Care
Are you involved in any HIV/AIDS activities? Please indicate which type of HIV/AIDS activity you have conducted, if any. Enter 'yes' next to each type of activity in which you have been involved. Prevention activities (A, AB, other) Care for people living with AIDS (PLWA) and their families Care for orphans and vulnerable children (OVC) Training service providers Strengthening organizations/providing technical assistance to organizations Other (please describe briefly)

If applicable, please provide an example of how you have integrated HIV/AIDS activities into your work assignment.

Are you involved in an HIV/AIDS task force?

2. Information and Communication Technology
Are you involved in any ICT activities? Which kind of ICT activity BEST describes the main focus of your work in ICT? (put a 'yes' next to just one of the types of ICT activities listed below) Radio/Audio TV/Video Computer Skills Internet- or web-based instruction or training Assisted community to set up and manage a computer lab in a community or school Assisted community in obtaining computer equipment Assisted community in obtaining Internet connectivity Other (please describe): If applicable, please provide an example of how you integrated ICT activities into your work assignment.

Please list titles of any ICT materials you have developed or contributed to. Videos Tape recordings

Printed matter Other materials

3. Women in Development/Gender and Development (WID/GAD)
Please provide an example of how you have integrated gender into your work assignment.

What tools, if any, did you use to integrate a gender and development approach into your primary work assignment? Type a 'yes' next to each tool you have used. Participatory Analysis for Community Action (PACA) Participatory Rural Appraisal (PRA) Gender Analysis The Gender Analysis Matrix in PDM Daily activity schedule Seasonal calendar Community mapping Priority ranking Other (Please describe below):

4. Youth Development
Please provide an example of how you have integrated youth development into your primary work assignment.

If you have developed any youth development materials, tools, or resources please describe them below.

Go to Main Menu

Purpose:

Disenfranchised and low-income communities in the Eastern Caribbean have improved their quality of life by -transforming from recipients of aid into partners in change, reducing HIV/AIDS prevalence rates, improving overall health, and enhancing educational and employability skills. Goal One

Goal 1:

Targeted groups and organizations will increase their abilities to identify, evaluate, develop, and implement solutions to community priorities By Sept 2011, Vs and community partners will have trained 300 community leaders and

Objective 1.1 managers of organizations, including small businesses and those addressing HIV/AIDS,

on participatory assessment tools or PACA.
Objective 1.2

By Sept 2011, Vs and community partners will provide technical assistance to 30 communities in developing or improving existing community development plans.

By Sept 2011, Vs and community partners will train and assist 100 community organizations in implementing the priorities outlined in their community development Objective 1.3 plans by providing technical assistance in project development, project implementation, operational procedures, IT use, and monitoring & evaluation. By Sept 2011, Vs and community partners will have trained and/or assisted 150 community leaders and managers of organizations and small businesses, including Objective 1.4 those addressing HIV/AIDS, on organizational strengthening tools such as the “NGO Capacity Profile Tools”. GOAL TWO
Goal 2:

Community members including in & out of school children and youth will improve their learning through exposure to innovative teaching methods and participation in community service programs By Sept 2011, Vs and community partners will have trained and assisted 200 educators on special education methodologies.

Objective 2.1

Objective 2.2 By Sept 2011, Vs will co-teach 1,500 special education students.

Objective 2.3

By Sept 2011, Volunteers and community partners will have raised awareness and advance the interests of children, youth, and adults with special needs. By Sept 2011, Vs and community partners will have provided basic literacy and

Objective 2.4 remedial education to 5000 youth and adult students in their communities and train

1000 service providers. By Sept 2011, Vs and community partners will have exposed 500 children and youth to
Objective 2.5 character education programs including the Virtues, sports, and music programs aimed

at strengthening self confidence and reducing deviant behavior.
Objective 2.6

By Sept 2011, Vs and community partners will have provided training to 300 children, youth, and adults on Information Technology and Communication tools. By Sept 2011, Vs and community partners will have increased community involvement in local voluntary activities. GOAL THREE

Objective 2.7

Goal 3:

Communities will develop and implement behavior change interventions targeting prevention of HIV/AIDS and 6 chronic diseases and support to those living with the diseases.

By Sept 2011, Vs and community partners will have trained 200 community leaders and
Objective 3.1 managers of organizations on Behavior Change Communication (BCC) and/or Behavior

Change and Information (BCI) methodologies By Sept 2011, Vs and community partners will have disseminated information to 2000
Objective 3.2 community members, on HIV/AIDS FACTS in regards to prevention, support, and

stigma & discrimination.
Objective 3.3

By Sept 2011, Vs and community partners will have trained 300 youth and children on Life Skills. By Sept 2011, Vs and community partners will have participated in the creation and/or

Objective 3.4 strengthening of an HIV/AIDS network of NGOs to promote effective collaboration on

the implementation of the National AIDS Plan.

DEFINITIONS OF TERMS
Go to Main Menu Go to Activities Worksheet Go to HIV/AIDS definitions below

Activities. Activities include the major areas of work Volunteers undertake to achieve a project's objectiv include, for example, delivering teacher training workshops, organizing farmer cooperatives, or assessing health service needs. In reporting activities and outputs, include in your description: --the number of Volunteers engaged in the activity --the immediate outputs of those activities. For example: "5 PCVs and their counterparts co-facilitated 20 workshops for youth leaders to increase their knowledge and malaria) prevention practices."

or, "11 PCVs and their counterparts organized local water committees in 22 communities and held one round gather information about wat/san needs."

Participant. A participant is an individual, service provider, organization or community who participates i primary or secondary activities. Participants are considered direct beneficiaries, since they interacted d Volunteer.

Indirect beneficiary. An indirect beneficiary is someone who did not participate in a Volunteer activity, benefited from the activity. For example, an Education Volunteer trains 10 teachers in improved teaching trained teachers go on to use the new teaching methods in the classroom, which results in improved stud this case, the students would be indirect beneficiaries, since they benefited from the Volunteer activity, ev Volunteer didn't work with the students directly. Indirect beneficiaries should be reported in the outcome appropriate objective, and not in the capacity building tables Capacity building levels. Capacity building levels describe the four main groups that Volunteers assist individuals, service providers, organizations, and communities.

Individuals. Individuals are people that Volunteers assist or reach directly, for example, community me farmers, or small business owners.

Service Providers ("Persons Trained"). Service providers are people Volunteers assist or train, who in tu services to others. Examples of service providers could include teachers, health clinic workers, communit educators, etc. Volunteer activities that build capacity at this level could include teacher training worksho worker trainings, for example.

Organizations. Organizations include schools, governmental or non-governmental organizations (NGOs) based organizations (CBOs), health clinics, informal community groups, associations, cooperatives, and ot Organizational capacity building activities might include assisting an organization with strategic planning, management, or strengthening organizational policies or systems.

Communities. Communities are groups of people living in the same geographic area, usually a village o Community capacity building activities typically have a community focus, such as raising awareness about environmental issues affecting a community. If a Volunteer works with members of a community, that Vo report assisting that community as well as the community members.

Outcomes. Please report the outcomes of the activities and related outputs described under ‘activities.’ CHANGE in knowledge, skills, attitude, behavior, or condition of project participants and their communitie

If an activity has not yet led to an outcome; or if the Volunteer(s) can not state with some confidence tha contributed to the observed outcome, please leave the 'outcome' space blank.

Sample outcome statement: “50 youth leaders demonstrated an increased understanding of how to prevent malaria and HIV transmiss by pre and post knowledge tests."

or, "8 communities changed their behavior regarding control of potable water by developing plans to improve water and presenting them to municipal health officials.

DEFINITIONS for HIV/AIDS ACTIVITIES AND TRAINING

Activities to promote abstinence or be faithful (AB). Activities or programs that promote abstinence the:

Importance of faithfulness in reducing the transmission of HIV among individuals in long-term sexual partn Elimination of casual sex and multiple sexual partnerships; Development of skills for sustaining marital fidelity;

Adoption of social and community norms supportive of marital fidelity and partner reduction using strateg and respond to local customs and norms; and

Adoption of social and community norms that denounce forced sexual activity in marriage or long-term pa Activities to promote abstinence only (A). Activities or programs that only promote the: Importance of abstinence in reducing the prevention of HIV transmission among unmarried individuals; Decision of unmarried individuals to delay sexual activity until marriage;

Development of skills in unmarried individuals for practicing abstinence; and

Adoption of social and community norms that support delaying sex until marriage and that denounce forc among unmarried individuals. NOTE: Abstinence only (A) is a subset of abstinence and/or be faithful (AB) Activities beyond primarily abstinence and/or be faithful messages ("other")

Other activities aimed at preventing HIV transmission including purchase and promotion of condoms, sexu infections (STI) management (if not in palliative care settings/context), messages/programs to reduce inj and related risks.

Organizations include governmental or nongovernmental organizations (NGOs), community-based organ faith-based organizations (FBOs), as well as informal community groups, associations, and cooperatives.

Technical assistance to organizations includes activities that build capacity of organizations, such as org development (building management skills, developing organizational skills and materials, improving recor systems), stigma and discrimination reduction workshops, community mobilization activities, and grief an

Orphans and Vulnerable Children (OVC) Care is any medical, psychological, spiritual, or social suppor OVC, including school-related support. OVC care includes activities to improve lives of children (under 18 directly affected by AIDS by strengthening communities to meet needs of orphans and vulnerable children community-based responses, helping children and adolescents by training caregivers, increasing access to economic support, and adding food and nutrition interventions.

Palliative Care is any medical, psychological, spiritual, or social support provided to PLWA and families. includes all clinic based and home/community-based activities to improve quality of life of HIV-infected cli families through management of infections such as malaria and HIV/AIDS related complications, as well a support, legal aid, housing, training and support for caregivers. People Living With AIDS (PLWA). Clients infected with HIV/AIDS. Same as PLHA, PLWHA, PHA.

Training of Service Providers means training activities that build the knowledge and skills of service pr nurses, caregivers, clinic workers, youth peer educators, community health care professionals, other med teachers, NGO leaders, managers of cooperatives, and other leaders. Training includes such events as wo conferences, and one-on-one coaching. To qualify as a training event, there must be a curriculum and exp objectives or expected competencies to be acquired.

Prevention activities include programs, services, and activities to help prevent transmission of HIV/AID community outreach, peer education, classroom and small-group education, and sexually transmitted infe management services.

Attendance Sheet
Name of activity: Date of activity: Obj. # or secondary activity: Location of activity:

Participant's Name

Other information (e.g.nickname)

Name of organization

Name of community

under or over 25?

Sex

Individual or Service Provider?

Attendance Sheet
Name of activity: Date of activity: Obj. # or secondary activity: Location of activity:

Participant's Name

Other information (e.g.nickname)

Name of organization

Name of community

under or over 25?

Sex

Individual or Service Provider?

Attendance Sheet
Name of activity: Date of activity: Obj. # or secondary activity: Location of activity:

Participant's Name

Other information (e.g.nickname)

Name of organization

Name of community

under or over 25?

Sex

Individual or Service Provider?

Attendance Sheet
Name of activity: Date of activity: Obj. # or secondary activity: Location of activity:

Participant's Name

Other information (e.g.nickname)

Name of organization

Name of community

under or over 25?

Sex

Individual or Service Provider?

Attendance Sheet
Name of activity: Date of activity: Obj. # or secondary activity: Location of activity:

Participant's Name

Other information (e.g.nickname)

Name of organization

Name of community

under or over 25?

Sex

Individual or Service Provider?

Go to Main Menu Outcome indicators (These indicators describe participant outcomes we are trying to achieve in this project. They are intended to ease recording of key changes you have observed or measured in the knowledge, skills, attitudes, behaviors, or condition of project participants.)

Question or Measure for Outcome Indicators (e.g. For 1.1.c. "Name one new skill you gained from the training that you have used in the past 6 months."

OFFICE OF COMMUNICATONS AUTHORIZATION TO USE PERSONAL MATERIAL

I, , hereby grant to the Peace Corps a perpetual, worldwide, royalty-free, license to use, reproduce, or publish, for purposes authorized by the Peace Corps Act: my name; the negative photographs, videotapes, and/or other audio or visual recordings of myself; my articles and stories; and any ot documents, writings, statements, recordings, representations, or information I may provide pursuant to and in with the terms of this Authorization.

In particular, I hereby authorize the Peace Corps to use, reproduce, or publish any or all of the above-listed ite make reference to me in connection with these items to promote the Peace Corps using various media and pub including, but not limited to: websites; books; public service advertising on television and radio stations; telev broadcasts; direct mail pieces; print advertisements; brochures; flyers; posters; articles; editorials; speeches; discussions; radio interviews; and television programs.

I acknowledge that I will receive no compensation from the Peace Corps in consideration of this Authorization o the above-listed items pursuant to this Authorization.

Name

Signature

Date