Form 1122-0012 Semi-Annual Progress Report for Education and Technical

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U.S. Department of Justice
Office on Violence Against Women
SEMI-ANNUAL PROGRESS REPORT FOR
Education and Technical Assistance Grants to
End Violence Against Women with Disabilities
Brief Instructions: This form must be completed for each Education and Technical Assistance Grants to End
Violence Against Women with Disabilities grant (Disability Education Grant) received. The grant administrator or
coordinator must ensure that the form is completed fully with regard to all grant-funded activities. Grant partners,
however, may complete sections relevant to their portion of the grant. Grant administrators or coordinators are
responsible for compiling and submitting a single report that reflects all information collected from grant partners.
All grantees should read each section to determine which questions they must answer based on the activities
supported under this grant during the current reporting period. Sections B and D and subsections A1 and C4 of
this form must be completed by all grantees. In subsections A2, C1-C3, and C5-C6 grantees must answer an initial
question about whether they engaged in the activities described in that subsection. If the response is yes, then
the grantee must complete the rest of that subsection. If the response is no, the rest of that subsection is
skipped.
The activities of volunteers or interns may be reported if they are coordinated or supervised by Disability Education
Grant-funded staff or if Disability Education Grant 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
Section A:
Section B:
Section C:
C1:
C2:
C3:
C4:
C5:
Section D:
Appendix A

General Information
Priority Areas
Function Areas
Training
Education
Technical Assistance
Coordinated Community Response
Product Development
Narrative

Page Number
11
44
55
55
88
10
10
12
12
13
13
14
15
15
16

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GENERAL INFORMATION
Grant Information

A1

All grantees must complete this section.
/

1.

Date of report

2.

Current reporting period

3.

Grantee name

4.

Grant number

/

(format date with 6 digits - 01/31/04)
✔

January 1-June 30

✔

July 1-December 31

(Year)

(The federal grant number assigned to your Disability Education Grant)

5.

Type of lead agency/organization
(Check the one answer which best describes the entity to whom the grant was awarded.)

State government
State sexual assault coalition
Tribal government
Tribal sexual assault and domestic
violence coalition
Unit of local government
University/college
Other (specify):

Community based organization
Disability agency/organization
Domestic violence program
Dual sexual assault/domestic violence
program
Dual state sexual assault and domestic
violence coalition
Faith-based organization
Sexual assault program
State domestic violence coalition
6.

Point of contact
(person responsible for the day-to-day coordination or administration of the grant)
First Name
Name

MI

Last Name

Agency/organization
Agency/organization name
(if
(if different
differentfrom
fromgrantee
grantee name)
name)
Address
Address
City
Telephone
Telephone
E-mail address
E-mail

7.

State
Facsimile
Facsimile

Zip Code

Does this Disability Education Grant specifically address tribal populations?
(Check yes if your Disability Education Grant focuses on tribal populations, and indicate which tribes or
nations you serve or intend to serve.)

Yes

No

If yes, which tribes/nations:

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8.

What percentage of your Disability Education Grant funds was directed to each of these areas?
(Provide appropriate percentages to reflect the time and/or resources you have devoted to each of these areas during the current reporting period. The total should equal 100%.)
Throughout this form, the term sexual assault includes both assaults committed by offenders who are
strangers to the victim/survivor and assaults committed by offenders who are known to, related by blood or
marriage to, or in a dating relationship with the victim. The term domestic violence applies to any pattern of
coercive behavior that is used by one person to gain power and control over a current or former intimate partner. Domestic violence includes dating violence, which is violence committed by a person who is or has been
in a social relationship of a romantic or intimate nature with the victim. Stalking is defined as a course of
conduct directed at a specific person that places that person in reasonable fear of the death of, or serious
bodily injury to, herself, a member of her immediate family, or her spouse or intimate partner. (See pages 2-3
of the separate instructions for more complete definitions.)
Percentage of grant funds

Sexual assault
Domestic violence
Stalking
TOTAL

100% 0%

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A2

Staff Information

Were Disability Education Grant funds used to fund staff positions during the current reporting period?
Check yes if Disability Education Grant funds were used to pay staff, including part-time staff and contractors.

Yes—answer question 9
No—skip to Section B
9.

Staff
(Report the total number of full-time equivalent [FTE] staff funded under this grant during the current reporting period. Include employees who are part-time and/or only partially funded with Disability Education Grant
funds, as well as contractors. If an employee or contractor was not employed or utilized over the entire reporting period, report the average. Round to the second decimal. See separate instructions for examples of
how to calculate FTEs for part-time staff and contractors.)
Staff

Grant-funded staff

Administrator (fiscal manager, executive director)
Advocate
Interpreter
Outreach worker
Program coordinator (training coordinator, outreach coordinator)
Support staff (secretary, administrative assistant)
Technical assistance provider
Trainer/educator
Other (specify):
TOTAL

0.00

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PRIORITY AREAS

B

All grantees must complete this section.

10. Priority areas
(Check all priority areas that apply to activities supported by Disability Education Grant funds during the
current reporting period.)
Check ALL
that apply

Priority areas
Provide education and technical assistance on the nature, definition, and characteristics of
sexual assault, domestic violence, and stalking experienced by women with disabilities2
Provide education and technical assistance on outreach activities to ensure that women
with disabilities who are victims of sexual assault, domestic violence, and stalking receive
appropriate assistance
Provide education and technical assistance on the requirements of shelters and victim services
organizations under Federal anti-discrimination laws, including the Americans with Disabilities
Act of 1990 and section 504 of the Rehabilitation Act of 1973
Provide education and technical assistance on cost-effective ways that shelters and victim
services may accommodate the needs of individuals with disabilities in accordance with the
Americans with Disabilities Act of 1990.

2

OVW recognizes that there are individuals who do not consider themselves to be “individuals with disabilities”
and who do not identify with this designation. However, for the purposes of the Disability Education Grant Program, “individuals with disabilities” refers to all individuals covered under the definition contained in the Americans with Disabilities Act (42 U.S.C. §12102(2)).

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C1

FUNCTION AREAS
Training

Were your Disability Education Grant funds used to provide training during the current reporting period?
Check yes if Disability Education Grant-funded staff provided training, or if grant funds directly supported
training.

Yes—answer questions 11-13
No—skip to C2
For the purposes of this reporting form, training means providing information on sexual assault, domestic
violence, and stalking that enables a person to improve her/his response to victims/survivors with disabilities as it relates to her/his role in the system. Education means providing general information that will increase awareness and knowledge about sexual assault, domestic violence, or stalking against people with
disabilities. In this subsection, report information on training.

11. Number of training events
(Report the total number of training events provided during the current reporting period that were either
provided by Disability Education Grant-funded staff or directly supported by Disability Education Grant funds.
Also report the total number of training events for which interpretive services were provided. Staff development training provided to Disability Education Grant-funded staff should not be counted.)
Total number of training events provided
Total number of training events for which interpretive services were provided:

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12. Number of people trained
(Report the number of people trained by Disability Education Grant-funded staff or with Disability Education
Grant funds during the current reporting period.)
People trained

Number

Adult protective services staff
Community advocacy organization staff (P& A, UCP, NAMI)
Court personnel (judges, clerks)
Disability organization staff (non-governmental, non-residential)
Domestic violence program staff
Dual sexual assault and domestic violence program staff
Educators (university, school staff)
Faith-based organization staff
Government agency staff (INS, Social Security, TANF, DHS)
Health/mental health professionals (excluding sexual assault forensic examiners)
Immigrant organization staff (non-governmental)
Interpreters
Job training program staff (vocational rehabilitation, occupational training)
Law enforcement officers
Multidisciplinary group
Personal care attendants
Prosecutors
Residential, institutional, or independent living center staff
Sexual assault forensic examiners
Sexual assault program staff
Social service organizations staff (homeless shelter, food pantry)
Transportation providers
Tribal government/agency staff
Victim-witness specialists
Volunteers
Other (specify):
TOTAL

0

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13. Training topics
(Check appropriate boxes to indicate all topics covered in training events provided by your Disability
Education Grant during the current reporting period.)

Sexual assault, domestic violence and stalking
Caregiver abuse overview, dynamics, and services
Confidentiality
Dating violence overview, dynamics, and services
Domestic violence overview, dynamics, and services
Mandatory reporting requirements for violence
against women with disabilities
Public benefits (TANF, disability, food stamps, SSI)
Safety planning for victims/survivors with disabilities
Sexual assault overview, dynamics, and services
Sexual exploitation overview, dynamics, and services
Stalking overview, dynamics, and services
Other (specify):

Disabilities and accessibility
Americans with Disabilities Act
Assistive technology and devices
Cost effective ways to accommodate victims/
survivors with disabilities
Disability rights and laws
Effective communication with individuals with
disabilities
Guardianship issues
Information on blindness or low vision
Information on cognitive disabilities
Information on deafness or hearing loss
Information on developmental disabilities
Information on medical disabilities and chronic
illness
Information on mental illness
Information on physical disabilities
Interpreter services
Outreach to victims/survivors with disabilities
Physical, attitudinal, and programmatic barriers
to accessibility
Protection and advocacy agencies
Recognizing and responding to violence against
women with disabilities
Resources for victims/survivors with disabilities
(local, state, federal, or tribal)
Technology as a safety issue
TTY, Assistive Listening Devices (ALD), and
relay services
Other (specify):

Criminal justice issues
Criminal codes specific to violence against
women with disabilities
Forensic evidence collection and victims/
survivors with disabilities
Hate crimes against people with disabilities
Identification and arrest of primary aggressor
Interpreters in the criminal justice process
Investigation of violence against women with
disabilities
Judicial response to violence against women
with disabilities
Law enforcement response to violence against
women with disabilities
Prosecution response to violence against
women with disabilities
Protection orders and women with disabilities
(including full faith and credit)
Women with disabilities as witnesses
Other (specify):

Issues specific to victims/survivors with
disabilities who:
are American Indian or Alaska Native
are Asian
are black or African American
are elderly
are Hispanic or Latino
are homeless or living in poverty
are immigrants, refugees, or asylum seekers
are isolated or institutionalized
are lesbian, gay, bisexual, transgender, or intersex
are Native Hawaiian or other Pacific Islander
have substance abuse problems
live in rural areas
Other (specify):

Health Care
Recognizing and responding to victims/survivors
with disabilities
Forensic evidence collection for victims/
survivors with disabilities
Institutional care issues for victims/survivors
with disabilities (includes residential, institutional or independent living centers)
Other (specify):

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Education

C2

Were your Disability Education Grant funds used to provide education during the current reporting
period?
Check yes if Disability Education Grant-funded staff provided education, or if grant funds directly supported
education.

Yes—answer questions 14-16
No—skip to C3
For the purposes of this reporting form, education means providing general information that will increase
awareness and knowledge about sexual assault, domestic violence, or stalking against people with disabilities. Training means providing information on sexual assault, domestic violence, and stalking that enables a
person to improve her/his response to victims/survivors with disabilities as it relates to her/his role in the
system. In this subsection, report information on education activities.

14. Number of education events
(Report the total number of education events provided during the current reporting period that were either
provided by Disability Education Grant-funded staff or directly supported by Disability Education Grant funds.
Also report the total number of education events for which interpretive services were provided.)
Total number of education events provided
Total number of education events for which interpretive services were provided

15. People educated with Disability Education Grant funds
(Report the number of people educated during the current reporting period.)
People attending event

Number

Community businesses (retail stores, pharmacies)
Community groups
Faith-based groups
Parents/guardians of individuals with disabilities
People with disabilities
Schools, universities
Other (specify):
TOTAL

0

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16. Education topics
(Check appropriate boxes to indicate all topics covered in education events provided by your Disability
Education Grant during the current reporting period.)

Sexual assault, domestic violence and stalking against women with disabilities
Caregiver abuse overview, dynamics, and services
Community resources for victims/survivors with disabilities
Dating violence overview, dynamics and services
Domestic violence overview, dynamics, and services
Overview of violence against women with disabilities
Physical and attitudinal barriers to accessibility
Recognizing and responding to violence against women with disabilities
Sexual assault overview, dynamics, and services
Sexual exploitation overview, dynamics, and services
Stalking overview, dynamics, and services
Other (specify):
Appropriate response to victims/survivors with disabilities who:
are blind or have low vision
have cognitive disabilities
are deaf or hard of hearing
have a physical disability
have developmental disabilities
have medical disabilities or chronic illness
have mental illness
live in residential or institutional facilities
Other (specify):

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C3

Technical Assistance

Were your Disability Education Grant funds used to provide technical assistance during the current
reporting period?
Check yes if Disability Education Grant-funded staff provided technical assistance, or if grant funds directly
supported technical assistance.

Yes—answer questions 17-19
No—skip to C4
17. Technical assistance
(Report the total number of technical assistance activities provided with Disability Education Grant funds during the current reporting period, indicating whether they were site visits to conduct accessibility assessments
or other consultations. Consultations may include in-person, telephone, electronic, or other types of contact.
Each contact should be counted as one activity.)
Technical assistance: A wide variety of activities designed to facilitate individual or agency change in some
systematic manner by providing expertise to solve a problem. Examples of technical assistance activities include clarifying legislative and policy implementation and/or standards of service, technology consultations,
and assistance with problem-solving.
People receiving technical assistance

Number of acces- Number of other
sibility assess- technical assistance
ment site visits
consultations

Adult protective services staff
Community advocacy organization staff (P&A, UCP, NAMI)
Court personnel (judges, clerks)
Disability organization staff (non-governmental, non-residential)
Domestic violence program staff
Dual sexual assault and domestic violence program staff
Educators (university, school staff)
Faith-based organization staff
Government agency staff (INS, Social Security, TAN, DHSF)
Health/mental health professionals (excluding sexual assault forensic examiners)
Immigrant organization staff (non-governmental)
Interpreters
Job training program staff (vocational rehabilitation, occupational training)
Law enforcement officers
Multidisciplinary group
Personal care attendants
Prosecutors
Residential, institutional, or independent living center staff
Sexual assault forensic examiners
Sexual assault program staff
Social service organizations staff (homeless shelter, food pantry)
Transportation providers
Tribal government/agency staff
Victim-witness specialists
Volunteers
Other (specify):
TOTAL

0

0

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18. Topics of technical assistance

18. Topics of technical assistance

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(Check appropriate boxes to indicate all topics covered in technical assistance provided with Disability Education Grant funds during the current reporting period.)
Accessibility assessment (physical, programmatic, attitudinal)
Accessible materials
Assistive technology and devices
Caregiver abuse
Collaboration and cross-training for responding to victims/survivors with disabilities
Cost-effective compliance with ADA
Court response to violence against women with disabilities
Culturally and racially appropriate services for victims/survivors with disabilities
Disability organizations’ response to violence against women with disabilities
Disability services and resources
Disclosure, confidentiality, and safety
Domestic violence experienced by women with disabilities
Effective communication with victims/survivors with disabilities
Guardianship and power of attorney issues
Health care response to violence against women with disabilities
Issues regarding victims/survivors living in residential or institutional facilities
Law enforcement response to violence against women with disabilities
Outreach to victims/survivors with disabilities
Personal safety planning for victims/survivors with disabilities
Prosecution response to violence against women with disabilities
Requirements of the Americans with Disabilities Act and other anti-discrimination laws
Responding to violence against victims/survivors who live in residential or institutional facilities,
or independent living centers
Responding to violence against women who are blind or have low vision
Responding to violence against women with cognitive disabilities
Responding to violence against women who are deaf or hard of hearing
Responding to violence against women with developmental disabilities
Responding to violence against women with medical disabilities and chronic illness
Responding to violence against women with mental illness
Responding to violence against women with physical disabilities
Service animals and accessibility
Sexual assault experienced by women with disabilities
Stalking experienced by women with disabilities
Technology as a safety issue
TTY, ALD and relay services
Victim services response to violence against women with disabilities
Working with interpreters
Other (specify)

19. Organizational policies and technical assistance
As a result of the technical assistance provided with Disability Education Grant funds, how many organizations developed, revised, and/or implemented polices regarding accessibility and/or services for women with
disabilities?

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C4

Coordinated Community Response
All grantees must complete this section.

20. Coordinated community response activities
(Check the appropriate boxes to indicate the agencies or organizations, even if they are not a memorandum
of understanding [MOU] partner, that you provided on-site consultation to; attended invitational meetings
with; engaged in development, revision, or implementation of training and/or education with; and/or, engaged in partnership and team building with during the current reporting period. In the last column, indicate
the agencies or organizations with which you have an MOU for purposes of the Disability Education Grant.)
PartnerDevelopment,
ship,
team
revision,
and/or
Invitational
On-site
MOU
Agency/Organization
implementation, of building,
consultation meetings
partner
and cross
training and/or
training
education
Adult protective services
Batterer Intervention Program
Community advocacy organization
(P&A, UCP, NAMI)
Court
Disability organization (nongovernmental, non-residential)
Domestic violence program
Dual sexual assault and domestic
violence program
Educational institution
Faith-based organization
Government agency (INS, Social
Security, TAN, DHS)
Health/mental health organization
(excluding sexual assault forensic
examiners)
Immigrant organization
(non-governmental)
Job training program staff
(vocational rehabilitation,
occupational training)
Law enforcement
Legal organization (legal services,
bar association)
Prosecutors
Residential, institutional, or
independent living center
Sexual assault forensic examiners
Sexual assault program
Social service organizations
(homeless shelter, food pantry)
Tribal government/agency
Other (specify)

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Product Development

C5

Were your Disability Education Grant funds used to develop, substantially revise, and/or distribute
products during the current reporting period?
Check yes if Disability Education Grant funds supported the development, substantial revision, and/or
distribution of products.

Yes—answer question 21
No—skip to section D
21. Use of Disability Education Grant funds for product development, substantial revision, and/or
distribution
(Report the number of products developed, substantially revised or distributed with Disability Education Grant
funds during the current reporting period. Report the number of new products developed or substantially revised during the current reporting period; the title/topic and intended audience for of each product developed, revised, and/or distributed; and the number of products used and/or distributed. The description of
the product should include the title, topic, and intended audience. If a product was created in or translated
into a language other than English, including Braille or sign language. Indicate the language. Report on products that were newly developed during the current reporting period whether or not they were used or distributed, and on products that were previously developed and were used and/or distributed during the current
reporting period.)
Products

Number
developed
or revised

Title/topic

Intended
audience

Number
used or
distributed

Other
languages

Brochures

Manuals

Training curricula

Training materials

Other (specify):

Question 21 continued on next page

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Question 21 continued.

Number
Products developed
or revised

Title/topic

Intended
audience

Number
used or
distributed

Other
languages

Training
materials

Other
(specify):

Tribal
codes

Other
(specify):

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NARRATIVE

D

All grantees must answer question 22.
Please limit your response to four pages for this question. To answer this question go to Page 16.

22. Report on the status of your Disability Education Grant goals and objectives for the current
reporting period.
(Using Appendix A as a guide, report on the status of the goals and objectives for your grant as of the end
of the current reporting period, as they were identified in your grant proposal, or as they have been added or
revised. Indicate whether the activities related to your objectives for the current reporting period have been
completed, are in progress, are delayed, or have been revised. Comment on your successes and challenges,
and provide any additional explanation you feel is necessary for us to understand what you have or have not
accomplished relative to your goals and objectives. If you have not accomplished objectives that should have
been accomplished during the current reporting period, you must provide an explanation.)

All grantees must answer questions 23 and 24 on an annual basis. Submit this information on the
January to June reporting form only.
Please limit your response to two pages for each question.

23. What do you see as the most significant areas of remaining need, with regard to obstacles faced
by individuals with disabilities? To answer this question go to Page 19.
(For example, we need more training of disability organization staff about violence against women with
disabilities; we struggle with negative community attitudes towards victims/survivors with mental illness.)

24. What has Disability Education Grant funding allowed you to do that you could not do prior to
receiving this funding? To answer this question go to Page 21.
(For example, we were able to train all victim service agencies in the state on the use of TTYs.)

Question 25 is optional.
Please limit your response to two pages for this question. To answer this question go to Page 23.

25. Provide any additional information that you would like us to know about your Disability
Education Grant and/or the effectiveness of your grant.
(If you have other data or information regarding the effectiveness of your Disability Education Grant-funded
program or that would more fully or accurately reflect your grant activities than the data you have been asked
to provide on this form, answer this question. If you have not already done so elsewhere on this form, you
may want to report on changes in accessibility of services for victims/survivors with disabilities; development, revision, or implementation of policies in your own agency; the sustainability of the grant activities;
and/or positive or negative unintended consequences, i.e. changed grantee’s own policies.)

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.

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APPENDIX A

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Describe your goals and objectives, as outlined in your grant proposal, or as revised - Question #22.
Goals/Objectives

Back to Instructions

Status

Key Activities

Comments

Goals/Objectives

Back to Instructions

Status

Key Activities

Comments

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APPENDIX A

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Describe your goals and objectives, as outlined in your grant proposal, or as revised - Question #22 (cont. 1).

Back to Instructions

Status

Back to Instructions

Status

Goals/Objectives

Key Activities

Comments

Goals/Objectives

Key Activities

Comments

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APPENDIX A

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Describe your goals and objectives, as outlined in your grant proposal, or as revised - Question #22 (cont. 2).

Back to Instructions

Status

Back to Instructions

Status

Goals/Objectives

Key Activities

Comments

Goals/Objectives

Key Activities

Comments

Education and Technical Assistance Grants Semi-annual Progress Report • 18 • Office on Violence Against Women

What do you see as the most significant areas of remaining need, with regard to increasing
victim/survivor safety and offender accountability? - Question #23

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What do you see as the most significant areas of remaining need, with regard to increasing
victim/survivor safety and offender accountability? - Question #23 (cont.)

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What has Disability Education Grant funding allowed you to do that you could not
do prior to receiving this funding? - Question #24

OMB Clearance # 1122-0012
Expiration Date: 10/31/2007

Back to Instructions
Education and Technical Assistance Grants Semi-annual Progress Report • 21 • Office on Violence Against Women

What has Disability Education Grant funding allowed you to do that you could not do prior to
receiving this funding? - Question #24 (cont.)

OMB Clearance # 1122-0012
Expiration Date: 10/31/2007

Back to Instructions
Education and Technical Assistance Grants Semi-annual Progress Report • 22 • Office on Violence Against Women

Provide additional information that you would like us to know about your Disability
Education Program and/or the effectiveness of your grant - Question #25.

OMB Clearance # 1122-0012
Expiration Date: 10/31/2007

Back to Instructions
Education and Technical Assistance Grants Semi-annual Progress Report • 23 • Office on Violence Against Women

Provide additional information that you would like us to know about your Disability
Education Program and/or the effectiveness of your grant - Question #25 (cont.).

OMB Clearance # 1122-0012
Expiration Date: 10/31/2007

Back to Instructions
Education and Technical Assistance Grants Semi-annual Progress Report • 24 • Office on Violence Against Women

OMB Clearance # 1122-0012
Expiration Date: 10/31/2007

Validate