DRAFT OMB Clearance # 11212-NNNN0011
Expiration Date: / /
U
.S.
Department of Justice
O
ffice
on Violence Against Women 
Semi-Annual Progress Report for
Grants to Support Tribal Domestic Violence and Sexual Assault Coalitions
Brief Instructions: This form must be completed for each Grant to Support Tribal Domestic Violence and Sexual Assault Coalition (Tribal Coalitions) grant received. The grant administrator or coordinator must ensure that the form is completed fully with regard to all grant activities. Throughout this form, Tribal Coalitions funds include the mandated 25% non-federal grant match. Is this still required?
All grantees should read through each section to determine which questions they must answer based on the activities engaged in under this grant during the current reporting period. Sections B, D and subsection A1 of this form must be completed by all grantees. In subsection A2 and section C, grantees must answer an initial question in each subsection about whether they engaged in certain activities during the current reporting period. If the response is yes, then the grantee must complete that subsection. If the response is no, the rest of that subsection is skipped.
For example, 1) if staff funded under this grantyou only provided training and technical assistance with staff funded under this grant during the current reporting period, you would complete sections and sub-sections A, A1, A2, B, C1, C6, and D (and answer ‘no’ in C2-C5 and C7-C9); or, 2) if staff funded under this grant you provided training and technical assistance with staff funded under this grant and grant-funded staff developed products during the current reporting period, you would complete sections A, B, C1, C4, C56, C6, and D (and answer ‘no’ in C2, C3, C5, and C7.-C9).
The activities of volunteers or interns mayshould be reported if they arewere coordinated or supervised by Tribal Coalitions grantProgram-funded staff or if Tribal Coalitions Program funds substantially support their activities.
For further information on filling out this form, refer to the separate set of instructions, which contains detailed definitions and examples, illustrating how questions should be answered.
SECTION Page Number
Section A: General Information 1 1
A1 Grant Information 1
A2 Staff Information 33
Section B: Purpose Areasrogram Activities 4
Section C: Function Areas 565
C1 Training 56
C2 Education 810 5
C3 2 System Advocacy 1281023
C34 Policies 1511357
C45 Products 14720172
C5 Education 13
C6 Topics of Technical Assistance 18515821
C7 Standards of Service 17
C8 Other Underserved Populations 18
C79 Organizational Development and Capacity Building 182042019
Section D: Narrative 19215201
Appendix A: Status of Goals and Objectives Table 21
A. General Information
A1. Grant information
All grantees must complete this section.
1. Date of report ____________________
2. Current reporting period  January 1- June 30  July 1-December 31 (Year)
3. Grantee name
4. Grant number (the federal grant number[s] assigned to your Tribal Coalitions Program grant)
5. Type of grantee organization (Check one)
EstablishedSexual assault tribal coalition
IndividualDomestic violence coalition
Other non-profitDual sexual assault/domestic violence coalition
6. Type of coalition
Tribal government
Sexual assault coalition
Domestic violence /dating violence coalition
Dual sexual assault and /domestic violence/dating violence coalition
67. Point of contact (person responsible for the day-to-day coordination or administration of the grant)
First Nname MI Last name
Agency/organization name (If different from grantee name)
Address
City_________________________State___________________Zip Code_____________________
Telephone Facsimile
78. What percentage of your tribal coalition operating budget is funded by this Tribal Coalitions Program
grant?
89. What tribal population(s) is(are) served by your Tribal Coalitions Program grant?
910. Did this tribal coalition exist prior to receiving Tribal Coalitions Program grant funds?
Yes
No
110. Coalition members (Report the total number of organizational members, including sexual assault programs, domestic violence /dating violence programs, other victim services agencies, and other organizational members., as applicable to your tribal coalition. Report the total number of individual members, if applicable, to of your tribal coalitions, if any. Individual members are individual persons, not programs.)
Coalition members | 
			Number | 
		
Sexual assault programs/rape crisis centers | 
			|
Domestic violence/dating violence programs | 
			|
Dual sexual assault and domestic violence/dating violence programs | 
			|
Tribal victim services agencies | 
			|
Other victim service providers | 
			|
Other organizational members | 
			|
Total number of organizational members | 
			|
Total number of individual members | 
			|
A
2.
 Staff Information
Were Tribal Coalitions Program funds used to fund staff positions during the current reporting period? Check yes if Tribal Coalitions Program funds were used to pay staff, including part-time staff and contractors.
Yes--answer question 121
No--skip to Section B
121. Staff (Report the total number of full-time equivalent [FTE] staff funded by your Tribal Coalitions Program grant during the current reporting period. Report staff by the function(s) performed, not by title or location. Include employees who are part-time and/or only partially funded with these grant funds as well as consultants/contractors. If an employee or contractor was not employed or utilized for only a portion of over the entire reporting period, prorate appropriately report the average. For example, if you hired a full-time administrator in October who was 100% funded with Tribal Coalition Program funds, you would report that as .5 FTEs. Report all FTEs in ound to the second decimals, not percentages. One FTE is equal to 1,040 hours—40 hours per week x 26 weeks. See separate instructions for examples of how to calculate FTEs for part-time staff and contractors.)
Staff  | 
			FTE(s)Grant-funded staff  | 
		
Administrator (executive director, fiscal manager)  | 
			
				  | 
		
Civil aAttorney  | 
			
				  | 
		
Communication specialist (public awareness, media relations)  | 
			
				  | 
		
Information technology staffpecialists  | 
			
				  | 
		
Native women/tribal cultural specialist  | 
			
				  | 
		
Paralegal  | 
			
				  | 
		
Program coordinator (training coordinator, outreach coordinator)  | 
			
				  | 
		
Support staff (secretary, administrative assistant, accountant, bookkeeper)  | 
			
				  | 
		
System advocate  | 
			
				  | 
		
Technical assistance provider  | 
			
				  | 
		
Trainer/educator  | 
			
				  | 
		
Tribal cultural specialist  | 
			
				  | 
		
Other(specify):_________________________________  | 
			
				  | 
		
Total  | 
			
				  | 
		
B
.
 PURPOSE AREASROGRAM ACTIVITIES
All grantees must complete this section.
132. Purpose Areasrogram Activities (Check all program activitiesurpose areas that apply to activities supported with Tribal Coalitions Program funds during the current reporting period.)
Check ALL that apply  | 
			Purpose Areasrogram activities  | 
		
| 
				 | 
			Increasing awareness of domestic violence/dating violence and sexual assault against American Indian and Alaska Native womenBringing local tribal programs together to identify gaps in services and to coordinate activities  | 
		
| 
				 | 
			Enhancing the response to violence against American Indian and Alaska Native women at the tribal, Federal, and State levels Conducting statewide, regional and/or tribally-based meetings or workshops for tribal victim advocates, survivors, community members, legal services staff, health care professionals, and criminal justice representatives  | 
		
| 
				 | 
			Identifying and providing technical assistance to coalition membership and tribal communities to enhance access to essential services to American Indian women victimized by domesticc/dating and sexual violenceCoordinating and presenting public awareness or community education programs (including education for youth) to increase understanding of domestic violence and sexual assault  | 
		
| 
				 | 
			Developing or enhancing appropriate standard of services for service providers  | 
		
				  | 
			Engaging in systems advocacy to effect policy and/or procedural change in order to improve institutional responses to domestic violence and sexual assault  | 
		
				  | 
			Establishing and maintaining an office and hiring staff (reasonable costs in connection with the establishment of an organization are allowable)  | 
		
| 
				 | 
			Expanding the capacity of coalitions  | 
		
				  | 
			Providing technical assistance to coalition members, programs, organizations, and service providers  | 
		
				  | 
			Providing limited direct services and advocacy to victims of domestic violence and sexual assault including crisis hotlines, assistance with shelter and transitional housing, court accompaniment, referrals, support groups, and civil legal services  | 
		
123a. Program priority areas addressed by your grant (In addition to the purpose areas identified above, the Tribal
Coalitions Grant Program Application and Program Guidelines may have identified several program priorities that would
receive priority consideration. If your project addressed any of these priority areas during the current reporting period,
list them below.)
			 
 
 
 
 
 
 
 
  | 
	
14. OtherCulturally-specific activities (List all other activities, not included in question 12, culturally-specific activities that which your tribal coalitions engaged in during the current
reporting period in the community(ies) you serve. Check the box in the first column if the activity was funded with Tribal
Coalitions Program funds.)
Tribal Coalitions funded  | 
			Activity  | 
		
| 
				 | 
			a.  | 
		
| 
				 | 
			b.  | 
		
| 
				 | 
			c.  | 
		
| 
				 | 
			d.  | 
		
| 
				 | 
			e.  | 
		
| 
				 | 
			f.  | 
		
15. (Optional) Additional iInformation (Use the space below to discuss the effectiveness of your culturally-specific activities funded or supported by your Tribal Coalitions Program grant and to provide further explanation on how these activities increase the safety of American Indian/Alaska Native women.)
C. FUNCTION AREAS
C
1.
Training
Were your Tribal Coalitions Program funds used for training during the current reporting period? Check yes if Tribal Coalitions Program-funded staff provided training or if Tribal Coalitions Program funds were used to directly support the training.
Yes--answer questions 164-196
No--skip to C2
For the purposes of this reporting form, training means providing information on sexual assault, dating violence, , domestic violence, and stalking that enables a personrofessionals to improve their response to victims/survivors as it relates to their role in the system. Education means providing general information that will increase public awareness of sexual assault, domestic violence, dating violence, and stalking. In this subsection, report information on training activities. Education should be reported in subsection C2.5
164. Type and number of training events provided (Report the number of statewide, regional, and tribal-based training events by the type of training that were either provided by Tribal Coalitions Program-funded staff or directly supported with Tribal Coalitions Program funds. Staff development training provided to Tribal Coalitions Program--funded staff should not be counted. Use the Sexual assault/Domestic violence /dating violence columns if training events focused on both sexual assault and domestic violence.)
Type of training  | 
		Total number of training events  | 
	||||||||
Statewide  | 
		Intra-state regions  | 
		Tribal  | 
	|||||||
Sexual assault  | 
		Domestic violence  | 
		Sexual assault//Domestic violence | 
		Sexual assault  | 
		Domestic violence  | 
		Sexual assault/Domestic violence | 
		Sexual assault  | 
		Domestic violence  | 
		Sexual assault //Domestic violence | 
	|
Computer-based training  | 
		
			  | 
		
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Conferences  | 
		
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			  | 
		
			  | 
	
Teleconferences  | 
		
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			  | 
	
Videoconferences  | 
		
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			  | 
	
Workshops/ seminars  | 
		
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			  | 
		
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			  | 
		
			  | 
	
Other (specify): __________  | 
		
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			  | 
		
			  | 
		
			  | 
	
1
75.
	Number
of people trained (Report
the number of people trained during the current reporting period by
Tribal Coalitions Program-funded staff or training supported by
Tribal Coalitions Program funds.  Use the category that is most
descriptive of the people attending the training event.  Tribal
Coalitions Program-funded staff attending staff development training
should not be counted. If you do not know how many people to report
in specific categories, you may report the overall number in
“Multidisciplinary.”.))
People trained  | 
			Number  | 
		
Attorneys/law students (does not include prosecutors)  | 
			
				  | 
		
Batterer intervention program/offender accountability staff  | 
			
				  | 
		
Child protective service workers  | 
			
				  | 
		
Children’s advocates (not affiliated with CPS)  | 
			
				  | 
		
Community advocacy organization staff (National Indian Council on Aging, National Congress of American Indians)  | 
			
				  | 
		
Correction personnel (probation, parole, and correctional facility staffies)  | 
			
				  | 
		
Court personnel (tribal—judges, clerks)  | 
			
				  | 
		
Court personnel (non-tribal—judges, clerks)  | 
			
				  | 
		
Domestic violence/dating violence program staff (tribal)  | 
			
				  | 
		
Domestic violence/dating violence program staff (non-tribal)  | 
			
				  | 
		
Educators (teachers, administrators, etc.)  | 
			
				  | 
		
Faith-based organization staff  | 
			
				  | 
		
Federal agency staff (BIA, IHHIS, FBI)  | 
			
				  | 
		
Health professionals (doctors, nurses; does not includeexcluding forensic examiners)  | 
			
				  | 
		
Law enforcement officers (tribal)  | 
			
				  | 
		
Law enforcement officers (non-tribal)  | 
			
				  | 
		
Legal services staff (does not include attorneys)  | 
			
				  | 
		
Mental health professionals  | 
			
				  | 
		
Military command staff  | 
			
				  | 
		
Multidisciplinary group (various disciplines at same training)  | 
			
				  | 
		
Other government agency staff (vocational rehabilitation, food stamps, TANF)  | 
			
				  | 
		
Prosecutors (tribal)  | 
			
				  | 
		
Prosecutors (non-tribal)  | 
			
				  | 
		
Sexual assault forensic examiners/sexual assault nurse examiners (SAFE/SANE)AFE/SANEexual assault forensic examiners  | 
			
				  | 
		
Sexual assault program staff (tribal)  | 
			
				  | 
		
Sexual assault program staff (non-tribal)  | 
			
				  | 
		
Social service organization staff (non-government—food bank, homeless shelter, etc.)  | 
			
				  | 
		
Tribal community groups  | 
			
				  | 
		
Tribal elders  | 
			
				  | 
		
Tribal government  | 
			
				  | 
		
Tribal government/Tribal government agency staff  | 
			
				  | 
		
Victim assistants (governmental, includes victim-witness specialist/coordinator)-witness specialists  | 
			
				  | 
		
Volunteers  | 
			
				  | 
		
Other (specify):  | 
			
				  | 
		
Total  | 
			
				  | 
		
168. Training content areas (Indicate all topics covered in training events provided bywith your Tribal Coalitions Program funds-funded staff or directly supported with Tribal Coalitions funds during the current reporting period. Check all that apply.)
Sexual assault, domestic violence/, dating violence and stalking
Advocacy for American Indian and/or Alaska Native women
Child custody in the context of violence against women
Child witnesses in the context of domestic violence/dating violence
Confidentiality
Cultural issues specific to American Indians and/or Alaska Natives
Dating violence overview, dynamics, and services
Domestic violence/dating violence overview, dynamics, and services
Drug facilitated sexual assault
Dynamics and history of violence against American Indian and/or Alaska Native women
Historical trauma
Indian Child Welfare Act
Safety planning for victims/survivors
Sexual assault overview, dynamics, and services
Stalking overview, dynamics, and services
Supervised visitation and exchange
Tribal strategies to address sexual assault or domestic violence
Other (specify):
	
Organizational community response
Coalition development
Collaboration
Coordinated community response
Discrimination and oppression issues
Evaluation
Federal agency response to sexual assault and domestic violence/dating violence (IHS, BIA, FBI, USAO)
Outreach
Program accessibility
Program rules
Public benefits (TANF, disability, food stamps, unemployment, etc.)
Response teams (DART, DVRT, SART)
Strategic planning
Technology
Tribal strategies to address sexual assault or domestic violence//dating violence, or stalking
Victim service administration and operations
Other (specify):
	
Other underserved populations
Issues specific to American Indian and Alaska Native victims/survivors who
are elderly
are disabled
are homeless or living in poverty
are isolated or institutionalized
are lesbian, gay, bisexual, transgender, or intersex
have disabilities
have mental health issuesproblems
have substance abuse issues
live in rural areas
live in urban areasproblems
Other (specify):_______________________
Justice system
Court procedures
Decreasing dual arrests/identifying predominant aggressor
	
Domestic violence/dating violence statues/codes development
Evidence analysis, collection, and preservation
Evidence-based prosecution
Firearms and domestic violence/dating violence
Immigration statutes
Judicial response
Law enforcement response (including protocols, arrest policies, and evidence collection)
Mandatory reporting requirements
Pro-arrest policies
Prosecution response
Protection orders (including full faith and credit)
Sex offender registry(ies)
Sexual assault forensic examinations
Sexual assault statutes/codes development
Stalking statutes/codes development
Tribal jurisdiction and Public Law 280
Other (specify)::
	
	
	
	
	
	
	
	
	
	
	
	
	
	
	
	
	
	
	
	
19. (Optional) Additional iInformation (Use the space below to discuss the effectiveness of your training activities funded or supported by your Tribal Coalitions Program grant and to provide further explanation on how these activities increase the safety of American Indian/Alaska Native women.)
	
	
	
	
C
2.
	 Education
Were your Tribal Coalitions Program funds used for education activities during the current reporting period? Check yes if Tribal Coalitions Program-funded staff engaged in were used to support education activities or if Tribal Coalitions Program funds were used to funds were used to directly support education activities.
Yes--answer questions 1720-1923
No--skip to C3
	
For the purposes of this reporting form, education means providing general information that will increase public awareness of sexual assault, domestic violence/dating violence, and stalking. Training means providing information on sexual assault, domestic violence, dating violence, and stalking that enables a professional to improve her/his response to victims/survivors of sexual assault, domestic violence/, dating violence, and stalking. In this subsection, report information on education activities.only. Training should be reported in subsection C1.
	
	
2017. Education events (Report the total number of education events provided during the current reporting period. that were either provided by Tribal Coalitions-funded staff or directly supported by Tribal Coalitions funds.)
	
Total number of education events provided _________
	
	
21. People educated with Tribal Coalitions Program funds (Report the number of people attending education events during the current reporting period. Use the category that is most descriptive of the people who attended the educational event.)
	
	
	
	
18. People educated with Tribal Coalitions funds (Report the number of people attending education events during the current reporting period.:TotalTOTAL  | 
				
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			|||
People attending event  | 
				Number  | 
				
					  | 
			|||
					  | 
				Tribal  | 
				Non- tribal  | 
				
					  | 
			||
Child care providers  | 
				
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Community businesses (retail stores, pharmacies)  | 
				
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Community groups (service or social groups)  | 
				
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Community members  | 
				
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Employers  | 
				
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Faith-based groups  | 
				
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Men’s groups  | 
				
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Parents/guardians  | 
				
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Students  | 
				
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Tribal elders  | 
				
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Tribal government/tribal government agency staff  | 
				
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Victims/survivors (do not count psycho-educational support groups)  | 
				
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Women’s groups  | 
				
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Other (specify)  | 
				
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Total  | 
				
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	2
219.
	Topics of education events provided with Tribal Coalitions Program
	funds (Indicate
	all topics covered in education provided with your Tribal Coalitions
	Program funds during the current reporting period.  Check all that
	apply.).
	
	
	
	
Sexual assault, domestic violence, /dating violence and stalking
Dating violence overview, dynamics and services
Domestic violence/dating violence overview, dynamics and services
Historical trauma
Indigenous awareness programs
Mandated reporting of child victimization
Safety planning
Sex offender registry(ies)
Sexual assault overview, dynamics, and services
Stalking overview, dynamics, and services
VAWA
Youth awareness of sexual assault, domestic violence/dating violence, and stalking
Workplace violence
Other (specify):
	
	
	
	
	
How to help American Indian or Alaska Native victims/survivors who:
are elderly
are homeless or living in poverty
are isolated or institutionalized
are lesbian, gay, bisexual, transgender, or intersex
have disabilities
have mental health issues
have substance abuse issues
live in rural areas
live in urban areas
Other (specify):
	
	
	
	
	
	
23. (Optional) Additional iInformation (Use the space below to discuss the effectiveness of your education activities funded or supported by your Tribal Coalitions Program grant and to provide further explanation on how these activities increase the safety of American Indian/Alaska Native women.)
C32. System Advocacy
Were your Tribal Coalitions Program funds used for system advocacy during the current reporting period? Check yes if Tribal Coalitions Program-funded staff engaged in system advocacy or if Tribal Coalitions Program funds were used to directly support system advocacy. (System advocacy is an activity intended to effect policy and/or procedural change in order to improve institutional response to sexual assault and/or domestic violence/dating violence.)
Yes--answer questions 240-272217-19
No--skip to C43
	
	
24017. System advocacy activities (Indicate the system advocacy activities convened or participated in with Tribal Coalitions Program funds during the current reporting period. Check all that apply.)
	
Systems advocacy  | 
			Sexual assault  | 
			Domestic violence/dating violence  | 
		
Appointed tribal and state commissions  | 
			
				 | 
			
				 | 
		
Community, regional, statewide task force/caucus  | 
			
				 | 
			
				 | 
		
Multidisciplinary working groups  | 
			
				 | 
			
				 | 
		
Project-specific interagency working groups  | 
			
				 | 
			
				 | 
		
Tribal systems advocacy  | 
			
				 | 
			
				 | 
		
Other (specify): _________________________  | 
			
				 | 
			
				 | 
		
	
	
	
	
	
	
	
	
	
	
	
	
	
	
	
	
	
	
	
	
	
	
	
	
	
	
	
	
	
	
	
	
	
	2
5118.
	Improved system response (Report
	the total number of statewide, regional, and local meetings convened
	and/or attended by Tribal Coalitions Program--funded staff during
	the current reporting period.  Report based on the primary group in
	attendance.  If there were multiple agencies or organizations at the
	meeting, count the meeting as a multidisciplinary meeting.  Each
	meeting should be counted only once.)
	
Agency/organization/people  | 
			Number of meetings convened  | 
			Number of meetings attended  | 
		||
				  | 
			Sexual assault  | 
			Domestic violence/dating violence  | 
			Sexual assault  | 
			Domestic violence/dating violence  | 
		
American Indian or Alaska Native women  | 
			
				  | 
			
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Batterer intervention program/offender accountability staff  | 
			
				  | 
			
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Child advocacy organization (not affiliated with CPS)  | 
			
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Child welfare agency  | 
			
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Community advocacy organizations (National Indian Council on Aging, National Congress of American Indians)  | 
			
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Corrections (probation, parole, correctional facility)  | 
			
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Court (tribal)  | 
			
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Court (non-tribal)  | 
			
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Crime victim compensation  | 
			
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Domestic violence/dating violence program (tribal)  | 
			
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Domestic violence/dating violence program (non-tribal)  | 
			
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Dual sexual assault and domestic violence/dating violence program (tribal)  | 
			
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Dual sexual assault and domestic violence/dating violence program (non-tribal)  | 
			
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Educational institution/Uuniversity/Sschool  | 
			
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Faith-based organization  | 
			
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Federal government agency staffies (IHS, BIA, FBI)  | 
			
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Government agency agency staff (INS, Social Security, TANFSstate and Llocal)  | 
			
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Health/mental health organization  | 
			
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Law enforcement agency (tribal)  | 
			
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Law enforcement agency (non-tribal)  | 
			
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Legal services organization (legal services, bar association, law school)  | 
			
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Multi-disciplinary group/task force  | 
			
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People representing other underserved populations  | 
			
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Prosecutor’s office (tribal)  | 
			
				  | 
			
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Prosecutor’s office (non-tribal)  | 
			
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Sexual Aassault Nnurse Eexaminer/sSexual Aassault Fforensic Eexaminer program (SANE/SAFE)FE/SANE programexual assault forensic examiner program  | 
			
				  | 
			
				  | 
			
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				  | 
		
Sexual assault program (tribal)  | 
			
				  | 
			
				  | 
			
				  | 
			
				  | 
		
Sexual assault program (non-tribal)  | 
			
				  | 
			
				  | 
			
				  | 
			
				  | 
		
Social services organization (food bank, homeless shelter)  | 
			
				  | 
			
				  | 
			
				  | 
			
				  | 
		
Substance abuse services  | 
			
				  | 
			
				  | 
			
				  | 
			
				  | 
		
Tribal community groups  | 
			
				  | 
			
				  | 
			
				  | 
			
				  | 
		
Tribal elders  | 
			
				  | 
			
				  | 
			
				  | 
			
				  | 
		
Tribal government/Tribal government agency  | 
			
				  | 
			
				  | 
			
				  | 
			
				  | 
		
Victims/survivors  | 
			
				  | 
			
				  | 
			
				  | 
			
				  | 
		
Victim assistant (governmental, includes victim-witness specialist/coordinator)-witness specialists  | 
			
				  | 
			
				  | 
			
				  | 
			
				  | 
		
Other (specify):  | 
			
				  | 
			
				  | 
			
				  | 
			
				  | 
		
Total  | 
			
				  | 
			
				  | 
			
				  | 
			
				  | 
		
	
	
	
	
	2
6219.
	Coordination activities (Indicate
	other methods used during the current reporting period to coordinate
	tribal victim services activities and/or to collaborate and
	coordinate with federal, state, and local entities engaged in
	activities to reduce or end violence against women.  Check all that
	apply.)
	
E-mail listserv
Fax
Newsletter
Telephone/conference call listserv
Toll-free telephone number
Tracking availability of victim services
U.S. Mail
Web site
Other (specify):
	
	
27. (Optional) Additional iInformation (Use the space below to discuss the effectiveness of your system advocacy activities funded or supported by your Tribal Coalitions Program grant and to provide further explanation on how these activities increase the safety of American Indian/Alaska Native women.)
C43. Policies
W
ere
	your Tribal Coalitions Program funds used to develop or,
	substantially revise, or implement policies or protocols during the
	current reporting period?  Check
	yes if Tribal Coalitions Program-funded staff developed or,
	substantially revised, or implemented policies or protocols or if
	Tribal Coalitions Program funds were used to directly support the
	development or, substantial revision, or implementation of policies
	or protocols.  
	
Yes--answer questions 28-2930
No--skip to C54
	
2830. Types of policies and/or protocols developed or, substantially revised, or implemented during the current reporting period. (Check all the policies or protocols developed ord, substantially revised, or implemented with Tribal Coalitions Program funds during the current reporting period. Use the SA column for policies and/or protocols addressing sexual assault and the DV column for those addressing domestic violence/dating violence.)
Victim services
SA  | 
			DV  | 
			
				  | 
		
| 
				 | 
			
				 | 
			Appropriate response to underserved populations  | 
		
| 
				 | 
			
				 | 
			Confidentiality  | 
		
| 
				 | 
			
				 | 
			Procedures for anonymous, confidential, or Jane Doe reporting of sexual assault  | 
		
| 
				 | 
			
				 | 
			Training standards for staff and volunteers  | 
		
| 
				 | 
			
				 | 
			Staff, board, and/or volunteers represent the diversity of your service area  | 
		
| 
				 | 
			
				 | 
			Standards of service  | 
		
| 
				 | 
			
				 | 
			Victim/survivor informed about Crime Victims Compensation and Victim Impact Statements  | 
		
| 
				 | 
			
				 | 
			Other (specify) : ______________________  | 
		
	
	
Law enforcement
SA  | 
			DV  | 
			
				  | 
		
| 
				 | 
			
				 | 
			Appropriate response to underserved populations  | 
		
| 
				 | 
			
				 | 
			Identifying primary aggressor/discouraging dual arrest  | 
		
| 
				 | 
			
				 | 
			Immediate access to protection order information  | 
		
| 
				 | 
			
				 | 
			Mandatory training on sexual assault, domestic violence/dating violence, and/or stalking  | 
		
| 
				 | 
			
				 | 
			No charge to sexual assault victims/survivors for any cost associated with forensic exam  | 
		
| 
				 | 
			
				 | 
			No victims/survivors polygraphed  | 
		
| 
				 | 
			
				 | 
			Pro-arrest/mandatory arrest  | 
		
| 
				 | 
			
				 | 
			Procedures for anonymous, confidential, or Jane Doe reporting of sexual assault  | 
		
| 
				 | 
			
				 | 
			Protection order enforcement (including full faith and credit)  | 
		
| 
				 | 
			
				 | 
			Providing information to victims/survivors about victim services  | 
		
| 
				 | 
			
				 | 
			Sexual assault response and protocolsProviding information to victims/survivors about victim services  | 
		
| 
				 | 
			
				 | 
			Stalking response and protocols  | 
		
| 
				 | 
			
				 | 
			Other (specify): ______________________  | 
		
	
	
Prosecution
SA  | 
			DV  | 
			
				  | 
		
| 
				 | 
			
				 | 
			Appropriate response to underserved populations  | 
		
| 
				 | 
			
				 | 
			Mandatory training on sexual assault, domestic violence/dating violence, and/or stalking  | 
		
| 
				 | 
			
				 | 
			No charge to victims/survivors for any costs related to the prosecution of sexual assault, domestic violence/dating violence and/or stalking  | 
		
| 
				 | 
			
				 | 
			No victims/survivors polygraphed  | 
		
| 
				 | 
			
				 | 
			Protection order enforcement (including full faith and credit)  | 
		
| 
				 | 
			
				 | 
			Sexual assault response and protocols  | 
		
| 
				 | 
			
				 | 
			Stalking response and protocols  | 
		
| 
				 | 
			
				 | 
			Vertical prosecution  | 
		
| 
				 | 
			
				 | 
			Victim witness notification  | 
		
| 
				 | 
			
				 | 
			Other (specify): _____________________  | 
		
	
	
Court
SA  | 
			DV  | 
			
				  | 
		
| 
				 | 
			
				 | 
			Accelerated trial schedules  | 
		
| 
				 | 
			
				 | 
			Appropriate response to underserved populations  | 
		
| 
				 | 
			
				 | 
			Dedicated sexual assault or domestic violence/dating violence docket  | 
		
| 
				 | 
			
				 | 
			Full faith and credit for protection orders  | 
		
| 
				 | 
			
				 | 
			Immediate access to obtain protection orders  | 
		
| 
				 | 
			
				 | 
			Judicial monitoring of sexual assault, domestic violence/dating violence, and/or stalking offenders  | 
		
| 
				 | 
			
				 | 
			Mandatory training on sexual assault, domestic violence/dating violence, and/or stalking  | 
		
| 
				 | 
			
				 | 
			No charge to sexual assault victim/survivor for any cost associated with forensic exam  | 
		
| 
				 | 
			
				 | 
			Policy against mutual restraining orders  | 
		
| 
				 | 
			
				 | 
			Procedures for courtroom security  | 
		
| 
				 | 
			
				 | 
			Other (specify): _______________________  | 
		
	
	
Probationon and parole policies
SA  | 
			DV  | 
			
				  | 
		||
| 
				 | 
			
				 | 
			Mandatory training on sexual assault, domestic violence/dating violence, and/or stalking  | 
		||
| 
				 | 
			
				 | 
			Strategies to assist and protect victims/survivors during probationon and parole  | 
		||
| 
				 | 
			
				 | 
			Perform checks on police logs, criminal and civil databases  | 
		||
| 
				 | 
			
				 | 
			Special procedures for cases involving diverse, underserved populations  | 
		||
| 
				 | 
			
				 | 
			Offender monitoring  | 
		||
| 
				 | 
			
				 | 
			Other (specify): ________________  | 
		||
	
	
Health care
SA  | 
			DV  | 
			
				  | 
		
| 
				 | 
			
				 | 
			Advocate response in emergency room  | 
		
| 
				 | 
			
				 | 
			Appropriate response to underserved populations  | 
		
| 
				 | 
			
				 | 
			Forensic evidence collection and documentation  | 
		
| 
				 | 
			
				 | 
			Forensic exams not billed to victims/survivors  | 
		
| 
				 | 
			
				 | 
			Mandatory training on sexual assault, domestic violence/dating violence, and/or stalking  | 
		
| 
				 | 
			
				 | 
			Routine screening and referrals for sexual assault, domestic violence/dating violence, and/or stalking  | 
		
| 
				 | 
			
				 | 
			Other (specify): ____________________  | 
		
	
	
	
	
29. (Optional) Additional iInformation (Use the space below to discuss the effectiveness of your policies you have developed or implemented that were funded or supported by your Tribal Coalitions Program grant and to provide further explanation on how these policies increase the safety of American Indian/Alaska Native women.)
	
	
	
	
	
	
	
	
	
	
	
	
	
	
	
	
	
	
	
	
	
	
	
	
	
	
	
	
	
	
	
	
	
	
	
	
	
	
	
	
	
	
	
	
	
	
	
	
	
	
	
	
	
	
	
	
	
	
C
54.
	 Products 
	
Were your Tribal Coalitions Program funds used to develop, substantially revise, or distribute products during the current reporting period? Check yes if Tribal Coalitions Program-funded staff developed products or if Tribal Coalitions Program funds were used to directly supported the development, revision, or distribution of products.
Yes--answer question 30241
No--skip to section C65
	
2430. Use of Tribal Coalitions Program funds for product development, substantial revision, or distribution (Report the number of products developed, substantially revised, or distributed with Tribal Coalitions Program funds during the current reporting period. Report the number of new products developed or substantially revised during the current reporting period; the title/topic; the intended audience for each product developed, revised, or distributed; and, the number of products used or distributed. If a product was created in or translated into a language other than English, including Braille, indicate the language. Report on products that were newly developed or substantially revised during the current reporting period whether or not they were used or distributed, and on products that were previously developed or revised but were used or distributed during the current reporting period. Do not report the number of products printed or copied; only report the number developed or revised—in most cases that number will be one for each product described—and/or the number used or distributed. See separate instructions for examples of how to report under “developed or revised” and “used or distributed”.)
	
Products  | 
				Number developed or revised  | 
				Title/topic  | 
				Intended audience  | 
				Number used or distributed  | 
				Other languages  | 
			
Brochures  | 
				|||||
Manuals  | 
				|||||
Newsletter  | 
				|||||
Training curricula  | 
				|||||
Training materials  | 
				|||||
Reports  | 
				|||||
Web site (report number of page views in the used or distributed column)  | 
				|||||
Videos  | 
				|||||
Tribal Codes  | 
				|||||
Other (specify): 
  | 
				|||||
	
C
5.
	 Education
Were your Tribal Coalitions funds used for education activities during the current reporting period? Check yes if Tribal Coalitions-funded staff were used to support education activities or if Tribal Coalitions funds were used to directly support education activities.
Yes--answer questions 22-25
No--skip to C6
	
For the purposes of this reporting form, education means providing general information that will increase awareness of sexual assault, domestic violence, and stalking. Training means providing information on sexual assault, domestic violence, and stalking that enables a person to improve her/his response to victims/survivors of sexual assault, domestic violence, and stalking. In this subsection, report information on education only.
	
	
22. Education events (Report the total number of education events provided during the current reporting period that were either provided by Tribal Coalitions-funded staff or directly supported by Tribal Coalitions funds.)
	
	
Total number of education events provided _________
	
	
23. People educated with Tribal Coalitions funds (Report the number of people attending education events during the current reporting period.)
	
	
People attending event  | 
			Number  | 
			
				  | 
		|
				  | 
			Tribal  | 
			Non- tribal  | 
		|
Child care providers  | 
			
				  | 
			
				  | 
		|
Community advocacy organizations (National Indian Council on Aging, National Congress of American Indians)  | 
			
				  | 
			
				  | 
		|
Community businesses (retail stores, pharmacies)  | 
			
				  | 
			
				  | 
		|
Community groups (service or social groups)  | 
			
				  | 
			
				  | 
		|
Community members  | 
			
				  | 
			
				  | 
		|
Employers  | 
			
				  | 
			
				  | 
		|
Faith-based groups  | 
			
				  | 
			
				  | 
		|
Men’s groups  | 
			
				  | 
			
				  | 
		|
Parents/guardians of students  | 
			
				  | 
			
				  | 
		|
Students  | 
			
				  | 
			
				  | 
		|
Tribal elders  | 
			
				  | 
			
				  | 
		|
Tribal government/tribal government agency staff  | 
			
				  | 
			
				  | 
		|
Victims/survivors (do not count psychoeducational support groups)  | 
			
				  | 
			
				  | 
		|
Women’s groups  | 
			
				  | 
			
				  | 
		|
Other (specify)  | 
			
				  | 
			
				  | 
		|
Total  | 
			
				  | 
			
				  | 
		|
	
	
	
	
	2
4.
	Topics of education events provided with Tribal Coalitions funds
	(Indicate
	all topics covered in education provided with your Tribal Coalition
	funds during the current reporting period.  Check all that apply).
	
	
	
	
Sexual assault, domestic violence and stalking
Dating violence overview, dynamics and services
Domestic violence overview, dynamics and services
Indigenous awareness programs
Mandated reporting of child victimization
Safety planning
Self-defense
Sexual assault overview, dynamics, and services
Sexual harassment overview, dynamics, and services
Stalking overview, dynamics, and services
Youth awareness of sexual assault, domestic violence, and stalking
Workplace violence
Other (specify):
	
	
How to help American Indian or Alaska Native victims/survivors who:
live in rural areas
are Asian
are black or African American
are disabled
are elderly
are Hispanic or Latino
are homeless or living in poverty
are immigrants, refugees, or asylum seekers
are lesbian, gay, bisexual, transgender, or intersex
are Native Hawaiian or other Pacific Islander
have mental health problems
have substance abuse problems
Other (specify):
	
	
	
	
C6. Technical Assistance
W
ere
	your Tribal Coalitions Program funds used to provide technical
	assistance during the current reporting period?
	 Check
	yes if Tribal Coalitions Program-funded staff provided technical
	assistance or if Tribal Coalitions Program funds were used to
	directlyly supported the provision of technical assistance.  
	
Yes--answer questions 3125-3326
No--skip to C7
	
31.25 Number of technical assistance activities (Report the total number of technical assistance activities provided to programs during the current reporting period, indicating whether they were site visits or other types of consultations. Consultations may include in-person, telephonic, electronic, or other types of contact. Each contact should be counted as one activity.)
	
Recipients of technical assistance  | 
				Number of site visits  | 
				Number of other technical assistance consultations  | 
			
Batterer intervention/offender monitor program  | 
				
					  | 
				
					  | 
			
Child welfare agency (Child Protective Services)  | 
				
					  | 
				
					  | 
			
Community advocacy organizations (National Indian Council on Aging, National Congress of American Indians)  | 
				
					  | 
				
					  | 
			
Corrections (probation, parole, correctional facility)  | 
				
					  | 
				
					  | 
			
Court (tribal)  | 
				
					  | 
				
					  | 
			
Court (non-tribal)  | 
				
					  | 
				
					  | 
			
Disability organization  | 
				
					  | 
				
					  | 
			
Domestic violence/dating violence program (tribal)  | 
				
					  | 
				
					  | 
			
Domestic violence/dating violence program (non-tribal)  | 
				
					  | 
				
					  | 
			
Dual sexual assault and domestic violence/dating violence program  | 
				
					  | 
				
					  | 
			
Elder organization  | 
				
					  | 
				
					  | 
			
Faith-based organization  | 
				
					  | 
				
					  | 
			
Federal agencies (BIA,CIA,FBI,IHS)  | 
				
					  | 
				
					  | 
			
Health/mental health organization  | 
				
					  | 
				
					  | 
			
Law enforcement (tribal)  | 
				
					  | 
				
					  | 
			
Law enforcement agency (non-tribal)  | 
				
					  | 
				
					  | 
			
Legal services organization (legal services, bar association, law school)  | 
				
					  | 
				
					  | 
			
Military command staff  | 
				
					  | 
				
					  | 
			
Other tribal coalition  | 
				
					  | 
				
					  | 
			
Prosecutor’s office (tribal)  | 
				
					  | 
				
					  | 
			
Prosecutor’s office (non-tribal)  | 
				
					  | 
				
					  | 
			
Sexual assault forensic examiners/sexual assault nurse examiners (SAFE/SANE)  | 
				
					  | 
				
					  | 
			
Sexual assault program (tribal)  | 
				
					  | 
				
					  | 
			
Sexual assault program (non-tribal)  | 
				
					  | 
				
					  | 
			
Tribal community groups  | 
				
					  | 
				
					  | 
			
Tribal government/Tribal government agency  | 
				
					  | 
				
					  | 
			
University/school  | 
				
					  | 
				
					  | 
			
Youth program  | 
				
					  | 
				
					  | 
			
Other (specify):  | 
				
					  | 
				
					  | 
			
Total  | 
				
					  | 
				
					  | 
			
	
	
	
	3
226.
	 Topics of technical assistance (Check
	the topics that apply to technical assistance provided with Tribal
	Coalitions Program funds during the current reporting period.  The
	technical assistance provided may be categorized by more than one
	topic.  Check all that apply.)
	
Topics of technical assistance  | 
				Sexual assault  | 
				Domestic violence/dating violence  | 
			
Coordinated community response  | 
				
					 | 
				
					 | 
			
Court response  | 
				
					 | 
				
					 | 
			
Criminal codes  | 
				
					 | 
				
					 | 
			
Curricula and training issues  | 
				
					 | 
				
					 | 
			
Developing or enhancing culturally appropriate services for underserved populations  | 
				
					 | 
				
					 | 
			
Developing or enhancing appropriate services for elder victims/survivors  | 
				
					 | 
				
					 | 
			
Developing or enhancing appropriate services for victims/survivors who have disabililtiesdisabilities  | 
				
					 | 
				
					 | 
			
Forensic evidence collection and documentation  | 
				
					 | 
				
					 | 
			
Law enforcement response  | 
				
					 | 
				
					 | 
			
Probation response  | 
				
					 | 
				
					 | 
			
Program development  | 
				
					 | 
				
					 | 
			
Program evaluation  | 
				
					 | 
				
					 | 
			
Prosecution response  | 
				
					 | 
				
					 | 
			
Response to dating violence victims/survivors  | 
				
					 | 
				
					 | 
			
Response to domestic violence/dating violence victims/survivors  | 
				
					 | 
				
					 | 
			
Response to sexual assault victims/survivors  | 
				
					 | 
				
					 | 
			
Response to stalking victims/survivors  | 
				
					 | 
				
					 | 
			
Safety planning  | 
				
					 | 
				
					 | 
			
Sex offender registry(ies)  | 
				
					 | 
				
					 | 
			
Standards of service  | 
				
					 | 
				
					 | 
			
Technology and technology capacity (data collection systems and confidentiality)  | 
				
					 | 
				
					 | 
			
Technology safety and security  | 
				
					 | 
				
					 | 
			
Tribal codes  | 
				
					 | 
				
					 | 
			
University/school  | 
				
					 | 
				
					 | 
			
Victim service administration and operations Other (specify): _____________________________________  | 
				
					 | 
				
					 | 
			
Other (specify):  | 
				
					 | 
				
					 | 
			
	
33. (Optional) Additional iInformation (Use the space below to discuss the effectiveness of your technical assistance activities funded or supported by your Tribal Coalitions Program grant and to provide further explanation on how these activities increase the safety of American Indian/Alaska Native women.)
	
	
C7. Standards of Service
W
ere
	your Tribal Coalitions funds used to develop or enhance standards of
	service for law enforcement, prosecution, courts, probation or
	victim services programs/agencies during the current reporting
	period? 
	Check
	yes if Tribal Coalitions-funded staff were used to develop or
	enhance standards of service or if Tribal Coalitions funds were used
	to directly support the development or enhancement of standards of
	service.
	 
	
Yes--answer question 27
No--skip to C8
	
	
27. Standards of service (Indicate if Tribal Coalitions funds were used to develop, implement, or enhance standards of service or provide training on standards of service for law enforcement, prosecution, courts, probation, or victim services programs/agencies. Check all that apply.)
					  | 
				Sexual assault  | 
				Domestic violence  | 
			
Developing standards of service for law enforcement, prosecution, courts, probation, and/or victim services  | 
				
					 | 
				
					 | 
			
Implementing standards of service for law enforcement, prosecution, courts, probation, and/or victim services  | 
				
					 | 
				
					 | 
			
Enhancing standards of service for law enforcement, prosecution, courts, probation, and/or victim services  | 
				
					 | 
				
					 | 
			
Training on standards of service for law enforcement, prosecution, courts, probation, and/or victim services  | 
				
					 | 
				
					 | 
			
	
	
	
	
	
	
C
8.
	 Other Underserved Populations
Were your Tribal Coalitions funds used to develop or enhance services for underserved populations or to encourage the representation of underserved populations in coordination activities during the current reporting period? Check yes if Tribal Coalitions-funded staff were used to develop or enhance services for underserved populations or if Tribal Coalitions funds directly supported representation of underserved populations in coordination activities.
Yes--answer question 28-29
No--skip to C9
	
	
28. Activities addressing underserved populations (Check all activities that were engaged in with Tribal Coalitions funds to develop or enhance services for underserved populations or to encourage the representation of underserved population in coordination activities. Check the boxes in the appropriate columns to indicate whether the activities you engaged in were for sexual assault or domestic violence programs/services.)
	
	
Activity  | 
				Sexual assault  | 
				Domestic violence  | 
			
Developing/distributing materials for underserved populations  | 
				
					 | 
				
					 | 
			
Developing policy  | 
				
					 | 
				
					 | 
			
Identifying gaps in services  | 
				
					 | 
				
					 | 
			
Identifying underserved populations  | 
				
					 | 
				
					 | 
			
Increasing organizational capacity for anti-oppression work  | 
				
					 | 
				
					 | 
			
Coordinating a task force/caucus to address issues concerning underserved populations  | 
				
					 | 
				
					 | 
			
Supporting representatives of underserved groups to participate in meetings  | 
				
					 | 
				
					 | 
			
Training/technical assistance regarding culturally appropriate services for underserved populations  | 
				
					  | 
				
					 | 
			
Other (specify):______________________________________________________  | 
				
					  | 
				
					 | 
			
	
29. Underserved populations (Indicate which underserved populations were addressed in the activities indicated in question 28. Check all that apply.)
	
	
American Indian and/or Alaska Native victims/survivors who:
are elderly
are homeless or living in poverty
are lesbian, gay, bisexual, transgender, or intersex
have disabilities
have mental health problems
have substance abuse problems
live in rural areas
Other (specify):
	
	
	
	
	
	
	
	
	
	
	
	
	
	
	
	
	
	
	
	
	
	
	C
79.
	 Organizational Development and Capacity Building of Tribal
	Coalitions
Were your Tribal Coalitions Program grant funds used for organizational development and/or capacity building during the current reporting period? Check yes if Tribal Coalitions Program-funded staff engaged in organizational development and/or capacity building activities, or if Tribal Coalitions Program grant funds were used to directly support organizational development and/or capacity building.
Yes--answer questions 3427-352830-31
No--skip to section D
	
	
342730. Coalition development and capacity building (Check all activities that were engaged in with Tribal Coalitions Program funds during the current reporting period.)
	
Activity  | 
			
				  | 
		
Anti-oppression work  | 
			
				 | 
		
Board member development  | 
			
				 | 
		
Communication (TTY, language lines, etc.)  | 
			
				 | 
		
Develop personnel policies  | 
			
				 | 
		
Emergency preparedness  | 
			
				 | 
		
Equipment purchase (computers, printers, faxes, telephones, cell phones, etc.)  | 
			
				 | 
		
Evaluation/outcome measures, development or tracking  | 
			
				 | 
		
Identify gaps in service  | 
			
				 | 
		
Internet/e-mail /listserv development  | 
			
				 | 
		
Office space (opening/maintaining)  | 
			
				 | 
		
Outreach to underserved populations  | 
			
				 | 
		
Software purchase or development  | 
			
				 | 
		
Staff development  | 
			
				 | 
		
Strategic planning  | 
			
				 | 
		
Technology security and safety  | 
			
				 | 
		
Toll-free telephone line operation  | 
			
				 | 
		
Web site development or enhancement  | 
			
				 | 
		
Other (specify):______________________  | 
			
				 | 
		
	
352831. Do you consider system privacy and/or security when purchasing or developing software?
Yes
No
	
	
	
	
	
	
	
	
	
	
	
	
	
	
	
	
	
	
	
	
D. NARRATIVE
	
	
All grantees must answer question 362932
Please limit your response to four pages for this question.
	
	
	
All grantees must answer questions 3703 and 34 318 on an annual basis. Please submit this information on the January to June reporting form only.
Please limit your response to two pages for each question.
	
	
	
	
Questions 39 and 4025 areis optional.
Please limit your response to two pages for each question.
	
	
	
	
	
	
	
	
	
	
	
	
Public Reporting Burden
Paperwork Reduction Act Notice. Under the Paperwork Reduction Act, a person is not required to respond to a collection of information unless it displays a currently valid OMB control number. We try to create forms and instructions that are accurate, can be easily understood, and which impose the least possible burden on you to provide us with information. The estimated average time to complete and file this form is 60 minutes per form. If you have comments regarding the accuracy of this estimate, or suggestions for making this form simpler, you can write to the Office on Violence Against Women, U.S. Department of Justice, 810 7th Street, NW, Washington, DC 20531.
APPENDIX A
	
Goals/Objectives (describe your goals and objectives, as outlined in your grant proposal, or as revised)
Key Activities  | 
			Status (e.g., completed, in progress, delayed, revised)  | 
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| File Type | application/msword | 
| File Title | DRAFT | 
| Last Modified By | catherine m. poston | 
| File Modified | 2008-04-28 | 
| File Created | 2008-04-28 |