Form 1 HM Combined

Healthy Marriage
OLDC Report Questions/Information for OFA HMRF Grantees to Enter into
OLDC System
Welcome [
], Grant number: [
Budget period: [XXX]
Report number: [XXX]
Priority Area: [
]
REPORTING PERIOD: [

]

] through [

]

1. Across all of your grant’s Allowable Activities, how many people
were served during the reporting period? This is an unduplicated count of people
served in all Allowable Activities during the reporting period.

a. Number served

2. Across all of your grant’s Allowable Activities, how many people
competed during the reporting period? This is an unduplicated count of people
completing in all Allowable Activities during the reporting period.

a. Number completed

or

data not collected

In case OFA or its contractors need to follow up on the information provided
in this submission, please provide the name and contact information for the
person who is providing the information.
Grant information provided by:
Name:
Title:
Telephone number: (

)

-

E-mail address:

1

Healthy Marriage
OLDC Report Questions/Information for OFA HMRF Grantees to Enter into
OLDC System
Welcome [
], Grant number: [
Budget period: [XXX]
Report number: [XXX]
Priority Area: [
]
REPORTING PERIOD: [

]

] through [

]

Allowable Activity 1: Public advertising campaigns on the value of
marriage and skills to increase marital stability and health
1. How many of each type of advertising did you purchase, have

donated, conduct or attend during the reporting period? Please give
the number purchased, donated, conducted or attended for each type. Enter 0s for
none.

a. newspaper ads (purchased/donated)

or

data not collected

b. TV spots (purchased/donated)

or

data not collected

c. billboards (purchased/donated)

or

data not collected

d. radio spots (purchased/donated)

or

data not collected

e. internet ads (purchased/donated)

or

data not collected

f. mailing campaigns (conducted)

or

data not collected

g. phone campaigns (conducted)
h. community events
(conducted/attended)

or

data not collected

or

data not collected

2. During the reporting period, how many people (“contacts”) saw

these advertisements or were exposed to the campaigns or events?
For community events, give the number of people (“contacts”)
who saw your materials. Please give the number for each type. Enter 0s for
none.

a. newspaper ads

or

data not collected

b. TV spots

or

data not collected

c. billboard ads

or

data not collected

d. radio spots

or

data not collected

e. internet ads

or

data not collected

f. mailing campaigns

or

data not collected

1

Healthy Marriage
OLDC Report Questions/Information for OFA HMRF Grantees to Enter into
OLDC System
g. phone campaigns

or

data not collected

h. community events

or

data not collected

In case OFA or its contractors need to follow up on the information provided
in this submission, please provide the name and contact information for the
person who is providing the information.
Grant information provided by:
Name:
Title:
Telephone number: (

)

-

E-mail address:

2

Healthy Marriage
OLDC Report Questions/Information for OFA HMRF Grantees to Enter into
OLDC System
Welcome [
], Grant number: [
Budget period: [XXX]
Report number: [XXX]
Priority Area: [
]
REPORTING PERIOD: [

]

] through [

]

Allowable Activity 2: Education in high schools on the value of
marriage, relationship skills, and budgeting

1. During this reporting period for the high school program (Allowable

Activity 2), how many students:
Were served in the program?
Completed the program?

or

data not collected

2. During this reporting period, which of these Healthy Marriage skills

did your program seek to improve?
(Mark ALL that apply)
a. Communication skills
b. Conflict resolution skills
c. Abuse prevention skills
d. Budgeting/financial skills

1

Healthy Marriage
OLDC Report Questions/Information for OFA HMRF Grantees to Enter into
OLDC System
3. How many were served and completed in each skill area? Please give the
number served under each skill area; this may be the same as the reported total number served.
Please also give the number completed under each skill area.

a. Communication skills

Students served
or
data not collected
Students completed
or
data not collected
or

b. Conflict resolution skills

activity not conducted

Students served
or
data not collected
Students completed
or
data not collected
or

c. Abuse prevention skills

activity not conducted

Students served
or
data not collected
Students completed
or
data not collected
or

d. Budgeting/financial skills

activity not conducted

Students served
or
data not collected
Students completed
or
data not collected
or

activity not conducted

2

Healthy Marriage
OLDC Report Questions/Information for OFA HMRF Grantees to Enter into
OLDC System
4. How many showed improvement in any of the four Healthy Marriage

skills?

This is an unduplicated count of those showing improvement in at least one of the

areas.

a. Of those served, number improved
or

data not collected

b. Of those completed, number improved
or

data not collected

5. Of those served in each skill area, how many showed improvement in

each of the following?
a. Communication skills

or

data not collected

b. Conflict resolution skills

or

data not collected

c. Abuse prevention skills

or

data not collected

d. Budgeting/financial skills

or

data not collected

6. Of those completed in each skill area, how many showed

improvement in each of the following?
a. Communication skills

or

data not collected

b. Conflict resolution skills

or

data not collected

c. Abuse prevention skills

or

data not collected

d. Budgeting/financial skills

or

data not collected

7. Of those served, how many showed improvement in the following?
a. Attitudes towards marriage

or

data not collected

3

Healthy Marriage
OLDC Report Questions/Information for OFA HMRF Grantees to Enter into
OLDC System

8. Of those completed, how many showed improvement in the

following?
b. Attitudes towards marriage

or

data not collected

9. Finally, how many students showed improvement in any of the above

areas, the four Healthy Marriage skills or in attitudes towards
marriage? This is an unduplicated count of those showing improvement in at least one of the
areas.

a. Of those served, number improved

or

b. Of those completed, number improved

or

data not
collected
data not
collected

10. How did your program measure improvement in Healthy Marriage
skills and attitudes towards marriage? Please describe your methods in the
space below.

11. Please attach an example copy of any instruments used to measure
improvement in marriage skills and attitudes towards marriage.

4

Healthy Marriage
OLDC Report Questions/Information for OFA HMRF Grantees to Enter into
OLDC System
In case OFA or its contractors need to follow up on the information provided
in this submission, please provide the name and contact information for the
person who is providing the information.
Grant information provided by:
Name:
Title:
Telephone number: (

)

-

E-mail address:

5

Healthy Marriage
OLDC Report Questions/Information for OFA HMRF Grantees to Enter into
OLDC System
Welcome [
], Grant number: [
Budget period: [XXX]
Report number: [XXX]
Priority Area: [
]
REPORTING PERIOD: [

]

] through [

]

Allowable Activity 3: Marriage education, marriage skills, and
relationship skills programs for non-married expectant parents

1.

During this reporting period for the marriage education, marriage
skills, and relationship skills programs for non-married expectant
parents (Allowable Activity 3), how many people:

Were served in the program?
Completed the program?

or

data not collected

2. During this reporting period, which of these Healthy Marriage

skills did your program seek to improve?
(Mark ALL that apply)
a. Communication skills
b. Conflict resolution skills
c. Abuse prevention skills
d. Budgeting/financial skills

1

Healthy Marriage
OLDC Report Questions/Information for OFA HMRF Grantees to Enter into
OLDC System
3. How many were served and completed in each skill area? Please give the
number served under each skill area; this may be the same as the reported total number served.
Please also give the number completed under each skill area.

a. Communication skills

People served
or

data not collected

People completed
or
data not collected
or

b. Conflict resolution skills

activity not conducted

People served
or

data not collected

People completed
or
data not collected
or

c. Abuse prevention skills

activity not conducted

People served
or

data not collected

People completed
or
data not collected
or

d. Budgeting/financial skills

activity not conducted

People served
or

data not collected

People completed
or
data not collected
or

activity not conducted

2

Healthy Marriage
OLDC Report Questions/Information for OFA HMRF Grantees to Enter into
OLDC System

4. How many showed improvement in any of the four Healthy

Marriage skills?

This is an unduplicated count of those showing improvement in at least

one of the areas.

a. Of those served, number improved
or

data not collected

b. Of those completed, number improved
or

data not collected

5. Of those served in each skill area, how many showed improvement

in each of the following?
a. Communication skills

or

data not collected

b. Conflict resolution skills

or

data not collected

c. Abuse prevention skills

or

data not collected

d. Budgeting/financial skills

or

data not collected

6. Of those completed in each skill area, how many showed

improvement in each of the following?
a. Communication skills

or

data not collected

b. Conflict resolution skills

or

data not collected

c. Abuse prevention skills

or

data not collected

d. Budgeting/financial skills

or

data not collected

3

Healthy Marriage
OLDC Report Questions/Information for OFA HMRF Grantees to Enter into
OLDC System
7. Of those served, how many showed improvement in each of the

following?
a. Attitudes towards marriage

or

data not collected

b. Relationship with their co-parent

or

data not collected

8. Of those completed, how many showed improvement in each of the

following?
a. Attitudes towards marriage

or

data not collected

b. Relationship with their co-parent

or

data not collected

9. Finally, how many showed improvement in any of the above areas,

the four Healthy Marriage skills, attitudes towards marriage, or
relationship with their co-parent? This is an unduplicated count of those showing
improvement in at least one of the areas.

a. Of those served, number improved

or

b. Of those completed, number improved

or

data not
collected
data not
collected

10. How did your program measure improvement in Healthy Marriage

skills, attitudes towards marriage, and relationship with their coparent? Please describe your methods in the space below.

4

Healthy Marriage
OLDC Report Questions/Information for OFA HMRF Grantees to Enter into
OLDC System
11. Please attach an example copy of any instruments used to measure

improvement in marriage skills, attitudes towards marriage, and
relationship with their co-parent.

In case OFA or its contractors need to follow up on the information provided
in this submission, please provide the name and contact information for the
person who is providing the information.
Grant information provided by:
Name:
Title:
Telephone number: (

)

-

E-mail address:

5

Healthy Marriage
OLDC Report Questions/Information for OFA HMRF Grantees to Enter into
OLDC System
Welcome [
], Grant number: [
Budget period: [XXX]
Report number: [XXX]
Priority Area: [
]
REPORTING PERIOD: [

]

] through [

]

Allowable Activity 4: Education and marriage skills training for
engaged couples or individuals interested in marriage
1. During this reporting period for the marriage skills training program

for engaged or individuals interested in marriage (Allowable Activity
4), how many people: Count each member of a couple as one person.
Were served in the program?
Completed the program?

or

data not collected

2. During this reporting period, which of these Healthy Marriage

skills did your program seek to improve?
(Mark ALL that apply)
a. Communication skills
b. Conflict resolution skills
c. Abuse prevention skills
d. Budgeting/financial skills

1

Healthy Marriage
OLDC Report Questions/Information for OFA HMRF Grantees to Enter into
OLDC System
3. How many were served and completed in each skill area? Please give the
number served under each skill area; this may be the same as the reported total number served.
Please also give the number completed under each skill area.

a. Communication skills

People served
or

 data not collected

People completed
or
data not collected
or

b. Conflict resolution skills

activity not conducted

People served
or

data not collected

People completed
or
data not collected
or

c. Abuse prevention skills

activity not conducted

People served
or

data not collected

People completed
or
data not collected
or

d. Budgeting/financial skills

activity not conducted

People served
or

data not collected

People completed
or
data not collected
or

activity not conducted

2

Healthy Marriage
OLDC Report Questions/Information for OFA HMRF Grantees to Enter into
OLDC System
4. How many showed improvement in any of the four Healthy

Marriage skills?

This is an unduplicated count of those showing improvement in at least

one of the areas.

a. Of those served, number improved
or

data not collected

b. Of those completed, number improved
or

data not collected

5. Of those served in each skill area, how many showed

improvement in each of the following?
a. Communication skills

or

data not collected

b. Conflict resolution skills

or

data not collected

c. Abuse prevention skills

or

data not collected

d. Budgeting/financial skills

or

data not collected

6. Of those completed in each skill area, how many showed

improvement in each of the following?
a. Communication skills

or

data not collected

b. Conflict resolution skills

or

data not collected

c. Abuse prevention skills

or

data not collected

d. Budgeting/financial skills

or

data not collected

7. Of those served, how many showed improvement in each of the

following?
a. Attitudes towards marriage

or

data not collected

b. Relationship with their fiancé/partner

or

data not collected

3

Healthy Marriage
OLDC Report Questions/Information for OFA HMRF Grantees to Enter into
OLDC System
8. Of those completed, how many showed improvement in each of

the following?
a. Attitudes towards marriage

or

data not collected

b. Relationship with their fiancé/partner

or

data not collected

9. Finally, how many showed improvement in any of the above

areas, the four Healthy Marriage skills, attitudes towards
marriage, or relationship with their fiancé/partner? This is an
unduplicated count of those showing improvement in at least one of the areas.

a. Of those served, number improved

or

b. Of those completed, number improved

or

data not
collected
data not
collected

10. How did your program measure improvement in Healthy

Marriage skills, attitudes towards marriage, and relationship with
their fiancé/partner? Please describe your methods in the space below.

11. Please attach an example copy of any instruments used to

measure improvement in marriage skills, attitudes towards
marriage, and relationship with their fiancé/partner.

4

Healthy Marriage
OLDC Report Questions/Information for OFA HMRF Grantees to Enter into
OLDC System
In case OFA or its contractors need to follow up on the information provided
in this submission, please provide the name and contact information for the
person who is providing the information.
Grant information provided by:
Name:
Title:
Telephone number: (

)

-

E-mail address:

5

Healthy Marriage
OLDC Report Questions/Information for OFA HMRF Grantees to Enter into
OLDC System
Welcome [
], Grant number: [
Budget period: [XXX]
Report number: [XXX]
Priority Area: [
]
REPORTING PERIOD: [

]

] through [

]

Allowable Activity 5: Marriage enhancement or marriage skills training
programs for married couples

1.

During this reporting period for the marriage enhancement program or
marriage skills training programs for married couples (Allowable
Activity 5), how many married people: Count each member of a couple as one
person.

Were served in the program?
Completed the program?

or

data not collected

2. During this reporting period, which of these Healthy Marriage

skills did your program seek to improve?
(Mark ALL that apply)
a. Communication skills
b. Conflict resolution skills
c. Abuse prevention skills
d. Budgeting/financial skills

1

Healthy Marriage
OLDC Report Questions/Information for OFA HMRF Grantees to Enter into
OLDC System
3. How many were served and completed in each skill area? Please give the
number served under each skill area; this may be the same as the reported total number served.
Please also give the number completed under each skill area.

a. Communication skills

People served
or

data not collected

People completed
or
data not collected
or

b. Conflict resolution skills

activity not conducted

People served
or

data not collected

People completed
or
data not collected
or

c. Abuse prevention skills

activity not conducted

People served
or

data not collected

People completed
or
data not collected
or

d. Budgeting/financial skills

activity not conducted

People served
or

data not collected

People completed
or
data not collected
or

activity not conducted

2

Healthy Marriage
OLDC Report Questions/Information for OFA HMRF Grantees to Enter into
OLDC System
4. How many showed improvement in any of the four Healthy

Marriage skills?

This is an unduplicated count of those showing improvement in at least

one of the areas.

a.

Of those served, number improved
or

data not collected

b. Of those completed, number improved
or

data not collected

5. Of those served in each skill area, how many showed

improvement in each of the following?
a. Communication skills

or

data not collected

b. Conflict resolution skills

or

data not collected

c. Abuse prevention skills

or

data not collected

d. Budgeting/financial skills

or

data not collected

6. Of those completed in each skill area, how many showed

improvement in each of the following?
a. Communication skills

or

data not collected

b. Conflict resolution skills

or

data not collected

c. Abuse prevention skills

or

data not collected

d. Budgeting/financial skills

or

data not collected

7. Of those served, how many showed improvement in each of the

following?
a. Commitment to marriage stability

or

data not collected

b. Relationship with their spouse

or

data not collected

3

Healthy Marriage
OLDC Report Questions/Information for OFA HMRF Grantees to Enter into
OLDC System

8. Of those completed, how many showed improvement in each of

the following?
a. Commitment to marriage stability

or

data not collected

b. Relationship with their spouse

or

data not collected

9. Finally, how many showed improvement in any of the above

areas, the four Healthy Marriage skills, commitment to marriage
stability, or relationship with their spouse? This is an unduplicated count
of those showing improvement in at least one of the areas.

a. Of those served, number improved

or

b. Of those completed, number improved

or

data not
collected
data not
collected

10. How did your program measure improvement in Healthy

Marriage skills, commitment to marriage stability, and
relationship with their spouse? Please describe your methods in the space
below.

11. Please attach an example copy of any instruments used to

measure improvement in marriage skills, commitment to
marriage stability, and relationship with spouse.

4

Healthy Marriage
OLDC Report Questions/Information for OFA HMRF Grantees to Enter into
OLDC System
In case OFA or its contractors need to follow up on the information provided
in this submission, please provide the name and contact information for the
person who is providing the information.
Grant information provided by:
Name:
Title:
Telephone number: (

)

-

E-mail address:

5

Healthy Marriage
OLDC Report Questions/Information for OFA HMRF Grantees to Enter into
OLDC System
Welcome [
], Grant number: [
Budget period: [XXX]
Report number: [XXX]
Priority Area: [
]
REPORTING PERIOD: [

]

] through [

]

Allowable Activity 6: Divorce reduction programs that teach
relationship skills

1.

During this reporting period for the divorce reduction program
(Allowable Activity 6), how many people: Count each member of a couple as
one person.

Were served in the program?
Completed the program?

or

data not collected

2. During this reporting period, which of these Healthy Marriage

skills did your program seek to improve?
(Mark ALL that apply)
a. Communication skills
b. Conflict resolution skills
c. Abuse prevention skills
d. Budgeting/financial skills

1

Healthy Marriage
OLDC Report Questions/Information for OFA HMRF Grantees to Enter into
OLDC System
3. How many were served and completed in each skill area? Please give the
number served under each skill area; this may be the same as the reported total number served.
Please also give the number completed under each skill area.

a. Communication skills

People served
or

data not collected

People completed
or
data not collected
or

b. Conflict resolution skills

activity not conducted

People served
or

data not collected

People completed
or
data not collected
or

c. Abuse prevention skills

activity not conducted

People served
or

data not collected

People completed
or
data not collected
or

d. Budgeting/financial skills

activity not conducted

People served
or

data not collected

People completed
or
data not collected
or

activity not conducted

2

Healthy Marriage
OLDC Report Questions/Information for OFA HMRF Grantees to Enter into
OLDC System
4. How many showed improvement in any of the four Healthy

Marriage skills?

This is an unduplicated count of those showing improvement in at least

one of the areas.

a.

Of those served, number improved
or

data not collected

b. Of those completed, number improved
or

data not collected

5. Of those served in each skill area, how many showed

improvement in each of the following?
a. Communication skills

or

data not collected

b. Conflict resolution skills

or

data not collected

c. Abuse prevention skills

or

data not collected

d. Budgeting/financial skills

or

data not collected

6. Of those completed in each skill area, how many showed

improvement in each of the following?
a. Communication skills

or

data not collected

b. Conflict resolution skills

or

data not collected

c. Abuse prevention skills

or

data not collected

d. Budgeting/financial skills

or

data not collected

3

Healthy Marriage
OLDC Report Questions/Information for OFA HMRF Grantees to Enter into
OLDC System
7. Of those served, how many showed improvement in each of the

following?
a. Commitment to marriage stability

or

data not collected

b. Relationship with their spouse

or

data not collected

8. Of those completed, how many showed improvement in each of

the following?
a. Commitment to marriage stability

or

data not collected

b. Relationship with their spouse

or

data not collected

9. Finally, how many showed improvement in any of the above

areas, the four Healthy Marriage skills, commitment to marriage
stability, or relationship with their spouse? This is an unduplicated count
of those showing improvement in at least one of the areas.

a. Of those served, number improved

or

b. Of those completed, number improved

or

data not
collected
data not
collected

10. How did your program measure improvement in Healthy

Marriage skills, commitment to marriage stability, and
relationship with their spouse? Please describe your methods in the space
below.

4

Healthy Marriage
OLDC Report Questions/Information for OFA HMRF Grantees to Enter into
OLDC System
11. Please attach an example copy of any instruments used to

measure improvement in marriage skills, commitment to
marriage stability, and relationship with spouse.
In case OFA or its contractors need to follow up on the information provided
in this submission, please provide the name and contact information for the
person who is providing the information.
Grant information provided by:
Name:
Title:
Telephone number: (

)

-

E-mail address:

5

Healthy Marriage
OLDC Report Questions/Information for OFA HMRF Grantees to Enter into
OLDC System
Welcome [
], Grant number: [
Budget period: [XXX]
Report number: [XXX]
Priority Area: [
]
REPORTING PERIOD: [

]

] through [

]

Allowable Activity 7: Marriage mentoring programs which use
married couples as role models and mentors in at-risk communities.

1. During this reporting period for the marriage mentoring program

(Allowable Activity 7), how many people:

Count only those being mentored

and count each member of a couple as one person.
Were served in the program?
Completed the program?

or

data not collected

2. During this reporting period, which of these Healthy Marriage

skills did your program seek to improve?
(Mark ALL that apply)
a. Communication skills
b. Conflict resolution skills
c. Abuse prevention skills
d. Budgeting/financial skills

1

Healthy Marriage
OLDC Report Questions/Information for OFA HMRF Grantees to Enter into
OLDC System
3. How many were served and completed in each skill area? Please give the
number served under each skill area; this may be the same as the reported total number served.
Please also give the number completed under each skill area.

a. Communication skills

People served
or

data not collected

People completed
or
data not collected
or

b. Conflict resolution skills

activity not conducted

People served
or

data not collected

People completed
or
data not collected
or

c. Abuse prevention skills

 activity not conducted
People served
or

data not collected

People completed
or
data not collected
or

d. Budgeting/financial skills

activity not conducted

People served
or

data not collected

People completed
or
data not collected
or

activity not conducted

2

Healthy Marriage
OLDC Report Questions/Information for OFA HMRF Grantees to Enter into
OLDC System
4. How many showed improvement in any of the four Healthy

Marriage skills?

This is an unduplicated count of those showing improvement in at least

one of the areas.

a. Of those served, number improved
or

data not collected

b. Of those completed, number improved
or

data not collected

5. Of those served in each skill area, how many showed

improvement in each of the following?
a. Communication skills

or

data not collected

b. Conflict resolution skills

or

data not collected

c. Abuse prevention skills

or

data not collected

d. Budgeting/financial skills

or

data not collected

6. Of those completed in each skill area, how many showed

improvement in each of the following?
a. Communication skills

or

data not collected

b. Conflict resolution skills

or

data not collected

c. Abuse prevention skills

or

data not collected

d. Budgeting/financial skills

or

data not collected

7. Of those served, how many showed improvement in each of the

following?
a. Commitment to marriage stability

or

data not collected

b. Relationship with their spouse

or

data not collected

3

Healthy Marriage
OLDC Report Questions/Information for OFA HMRF Grantees to Enter into
OLDC System

8. Of those completed, how many showed improvement in each of

the following?
a. Commitment to marriage stability

or

data not collected

b. Relationship with their spouse

or

data not collected

9. Finally, how many showed improvement in any of the above

areas, the four Healthy Marriage skills, commitment to marriage
stability, or relationship with their spouse? This is an unduplicated count
of those showing improvement in at least one of the areas.

a. Of those served, number improved

or

b. Of those completed, number improved

or

data not
collected
data not
collected

10. How did your program measure improvement in Healthy

Marriage skills, commitment to marriage stability, and
relationship with their spouse. Please describe your methods in the space
below.

11. Please attach an example copy of any instruments used to

measure improvement in marriage skills, commitment to
marriage stability, and relationship with their spouse.

4

Healthy Marriage
OLDC Report Questions/Information for OFA HMRF Grantees to Enter into
OLDC System
In case OFA or its contractors need to follow up on the information provided
in this submission, please provide the name and contact information for the
person who is providing the information.
Grant information provided by:
Name:
Title:
Telephone number: (

)

-

E-mail address:

5