Attachment 9 Progress Report and Core Measures Data Collection Final

Attachment 9:

Drug-Free Communities Progress Report

COALITION STRUCTURE AND PROCESSES SECTION (Note: The first time you enter the progress reporting system, all sections will be blank. If you are a continuing grantee who has previously entered data, you will be able to get a report that provides all previously submitted data. After you enter data for the first time, all sections will be prefilled. You will be prompted to check the information and select to edit it if any prior submitted data has changed.)
Date Updated: ___ /____
Grantee/Coalition Information
Grantee Name: _______________________ Award Number: ____________________ Coalition Name: _______________________ Year of First DFC Award: _______ Month and year your coalition was first established: ___/___ If your coalition is a SPF/SIG subrecipient, please enter your grant number. Our coalition is not a SPF/SIG subrecipient Our SPF/SIG subrecipient grant number is ____________ If your coalition is a STOP Act grantee, please enter your grant number. Our coalition is not a STOP Act grantee Our STOP Act grantee grant number is ____________
Total number of members participating in your coalition:____________ (Note: This number should include all members plus all staff (paid and volunteer) Number of paid staff: _________ Number of volunteer staff: ________
Coalition Director Contact Information: Name: ____________________________________ Title: _____________________________________ Address: __________________________________ ___________________________________ Phone: ____________________________________ Fax: ______________________________________ Email: ____________________________________ Month and year coalition director took current position: ____/_____ Did your coalition director change during this reporting period? Yes No If yes, please provide the month and year your previous coalition leader left the position: ____/_____
Does your coalition serve a federally-recognized Tribal area? Yes No	Is your coalition headed by a religious or faith-based organization? Yes No	Does your coalition have at least one (1) representative from the Bureau of Indian Affairs, the Indian Health Service, or a Tribal Government Agency with expertise in the field of substance abuse? Yes No
Please provide a brief summary of your coalition. This is your “Elevator Speech.” There should be about one sentence describing each of the following (a) your community and target population, (b) your primary goals, (c) the activities you are focusing on, (d) accomplishments to date, (e) successes concerning goal achievement, f) challenges in goal achievement, and g) things that make your coalition unique.

Needs Assessment Needs Assessment refers to the decisions your coalition has made concerning the major problems upon which you want to focus, the major community areas and populations you want to serve, and the reasons that these priorities were established. In addition, needs assessment refers to the ways you have collected data, or assessed the communities concern, to establish these priorities.
Geographic setting(s) served (check all that apply): Inner City Urban Suburban Rural Frontier		Community setting(s) served (check all that apply):
		Single School District Multiple School Districts Single School Multiple Schools				City Multiple Cities Town Multiple Towns				Neighborhood Multiple Neighborhoods County Region or Other Subsection of a State Native American/American Indian/Alaskan Native Reservation Military Colleges & Universities
Do you target information/intervention efforts to a specific minority group or minority groups? Yes No If yes, please specify (check all that apply): American Indian or Alaska Native Asian Black or African-American Hispanic or Latino Native Hawaiian or Other Pacific Islander Lesbian/Gay/Bisexual/Transgender (LGBT) Youth
Grade level(s) served (check all that apply):
Elementary school (K-5)	6th grade 7th grade		8th grade 9th grade				10th grade 11th grade		12th grade
Please select up to five (5) substances that your coalition is targeting in your community:
Alcohol Tobacco Marijuana Prescription Drugs Cocaine/Crack				Heroin Stimulants (uppers) Tranquilizers Hallucinogens Over-the-counter (OTC) drugs						Inhalants Steroids Synthetic Drugs/Emerging Drugs Additional substances addressed: __________
Target Zip Codes (Note: This section will be prefilled unless you have not entered data previously. You will be prompted to check the information and select to edit it if any prior submitted data has changed. You may also upload zip codes, but in order to do so, you MUST use the provided EXCEL file template.)
Zip Code Served					Do you serve the entire zip code? (Dropdown: Yes/No)			If no, please list the specific areas served (e.g., names of neighborhoods, school districts, etc.)

Coalition Budget (Note: This section will be prefilled unless you have not entered data previously. You will be prompted to check the information and select to edit it if any prior submitted data has changed.)
Prompted with: Has the information below changed from what was reported in previous reporting period? Yes* No (skip to next section - “Member Capacity”) What is your coalition's current total annual operating budget? $ _______________ Please specify the period that this budget covers: From: mm/dd/yyyy To: mm/dd/yyyy
What dollar amount of your total operating budget comes from each of the following funding sources? Source of Funding/Resources	Percentage (Note: The system will automatically calculate percentages for you. You will not enter this data.)	Dollar Amount (Note: Be sure the amounts below total to the amount submitted as your current total annual operating budget provided above.)
DFC grant
STOP Act grant
SPF-SIG funding
Other federal government funding
Other state government funding
Other local government funding
Foundation/Non-profit organizations
Private/Corporate entities
Individual donations/Funding from fundraising events
In-Kind contributions
Other (if applicable, please specify up to one other funding source) _____________________
In the next 12 months do you expect your coalition's funding level to: Increase Decrease Stay about the same
Comments: (NOTE: Provide any information relevant to understanding your expectations regarding your coalition’s funding level. Please note funding uncertainties, opportunities, or other information relevant for understanding your coalition’s future funding.):

MEMBER CAPACITY SECTION Capacity refers to the types (such as skills or technology) and levels (such as individual or organizational) of resources that a coalition has at its disposal to meet its aims.
Membership (Note: This section will be prefilled unless you have not entered data previously. You will be prompted to check the information and select to edit it if any prior submitted data has changed.)
Number of formal coalition meetings held during this period (This number should include all meetings where coalition work was occurring with members from across sectors): __________ Average attendance at coalition meetings: (not including paid staff. Volunteer staff should only be included if they are attending as a sector member): ______		Is collaboration among members of your coalition (NOTE: Think about the level of participation in coalition decisions, participation in joint activities, and other collaborative interactions in your prior reporting period relative to now.): Increasing Decreasing Staying the same
Sectors	How many coalition members represent this sector? *Note: Enter a number. If a member represents more than one sector please only count them once, under the sector that represents him/her best. For example you may have a police officer who is also a parent, but if they are there because on police force then indicate as law enforcement, not as parent.	How many of these coalition members are “active” (i.e., have attended at least one meeting in the past six months)?	What is the average level of involvement for each of the sectors?
			Very High	High	Medium	Some	Low
Parents							
Youth							
Business Community							
Civic/Volunteer Group							
Healthcare Professionals							
Law Enforcement agency							
Media							
Religious/Fraternal organizations							
Schools							
State, local, and/or tribal government agencies							
Youth-serving organizations							
Other Organization with Expertise in Substance Abuse (please specify up to one additional sector) ___________________							

Member Roster (Note: The Center for Substance Abuse Prevention (CSAP) requests that you enter a roster of all individuals and organizations involved in your coalition. You may also upload a member roster, but in order to do so, you MUST use the provided EXCEL file template.)
First Name (Note: If entering an organization enter organization name in last name and leave first name blank.)	Last Name (Note: If entering an organization enter organization name in last name and leave first name blank.)	Type (Note: You will select either individual or organization from drop down list.)	Sector (Note: Select from drop down: list of sectors. If you select “other” you will be asked to specify.)	Status (Note: Select from drop down menu if individual/organization is an active or inactive member of the coalition.)
Note: You will be able to enter as many members as needed.
What is being done to increase membership in the sectors not represented? (Note: This information is only requested if you do not list at least one member representing each sector.)

	Capacity Building Activities Capacity building activities include any efforts explicitly designed to improve the ability of the coalition to successfully assess needs, plan, make decisions, implement effective activities, evaluate, improve, and sustain coalition functioning.
	Please select up to three (3) capacity building activities that were the main focus of your coalition’s efforts during the last reporting period:
	Gathering community input (e.g., holding hearings on drug problems) Recruitment (e.g., increasing coalition membership and participation) Training for coalition members (e.g., building leadership capacity among coalition members) Building shared vision/consensus (e.g., attaining an agreement among coalition members regarding goals, planned initiatives, etc.) Increasing fiscal resources (e.g., attaining funding for substance abuse prevention initiatives) Strengthening interventions (e.g., planning/executing substance abuse prevention initiatives)	Outreach (e.g., engaging key stakeholders in substance abuse prevention initiatives) Engaging the general community in substance abuse prevention initiatives Developing/Executing a media plan to draw attention to new drug threats Improving information resources (e.g., engaging in research or evaluation activities) Other ( please specify ): _____________________ None
	Does your coalition have a youth coalition that meets separately? Yes No If yes, how often did the youth coalition meet over the last six months? Every 1-2 weeks Once a month Once every two months One to two times in the past six months What is the average level of involvement of the youth coalition in planning prevention activities with youth? Very High High Medium Some Low
	Please report any notable accomplishments related to capacity building activities achieved during this reporting period:
	Please report any additional details, including barriers or challenges, about your capacity building activities that were not captured above, but are relevant to understanding your coalition’s activities/outcomes:
COALITION PROCESSES SECTION
Challenges and Protective Assets Challenges or risk factors are characteristics of community, individuals, families, schools or other circumstances that increase the likelihood or difficulty of mitigating substance use and its associated harms. Prevention activities often focus on reducing risk factors that are perceived to be particularly important in a community.
What are the primary challenges that you face in your community? (Note: Select all that apply. When you select a factor, please answer the follow up question on trend data for that factor.)
Community Factors Inadequate laws/ ordinances related to substance use/access
Inadequate enforcement of laws/ordinances related to substance use
Availability of substances that can be abused
Perceived acceptability (or disapproval) of substance abuse
Individual Factors Favorable attitudes towards the problem behavior
Early initiation of the problem behavior
Family Factors Family trauma/stress
Parental attitudes favorable to antisocial behavior
Parents lack ability/ confidence to speak to their children about ATOD use
School Factors Academic failure
Low commitment to school
Other (please specify) Coalition can enter free-form text
Protective Factors Protective factors are characteristics of a community, individuals, families, schools or other circumstances that decrease the likelihood of substance use and its associated harms. Prevention activities often focus on strengthening protective factors that are perceived to be particularly important in a community.
Select the major protective factors that your coalition is targeting. (Note: Select all that apply. When you select a factor, please answer the follow up question on trend data for that factor.)
Community Factors Laws, regulations, and policies
Strong community organization (e.g., less crime, less visible drug dealing)
Advertising and other promotion of information related to ATOD use
Pro-social community involvement
Cultural awareness, sensitivity, and inclusiveness
Family Factors Family economic resources
Parental monitoring and supervision
Family connectedness
Opportunities for pro-social family involvement
Individual Factors Positive contributions to peer group
Recognition/acknowledgement of efforts
School Factors Contributions to the school community
Positive school climate
School connectedness
Other (please specify) Coalition can enter free-form text
Please report any additional details about your challenges and protective assets that were not captured above:

Assessment Activities

Assessment - The systematic gathering and analysis of data to identify current assets, problems, and related conditions that require intervention.

Please select up to three (3) assessment activities that were the main focus of your coalition’s efforts during the last reporting period:

• Preparing to assess needs and capacity (e.g., identifying coalition goals)

• Designing/selecting interventions

• Collecting data for assessment purposes

• Analyzing and reporting assessment data

• Completing a SWOT ( strengths, weaknesses, opportunities, and threats) analysis

• Developing a framework/logic model for change

• Using assessment data (e.g., revising a logic model)

• Other ( please specify ): _____________________

• None

Please report any notable accomplishments related to assessment activities achieved during this reporting period:

Please report any additional details, including barriers or challenges, about your assessment activities that were not captured above:

PLANNING SECTION Planning is a process of developing a logical sequence of steps that lead from individual actions to community-level drug outcomes and achievement of the coalition’s vision for a healthier community.
Planning Activities NOTE: Coalitions will be prompted to upload their strategic plan, logic model, and action plans. Anytime you change any of these documents, a new file should be uploaded.
Has your coalition made any modifications to your strategic plan during this reporting period? Yes No If yes, please describe: _______________________________	Has your coalition made any modifications to your Logic Model during this reporting period? Yes No If yes, please describe: _______________________________	Has your coalition developed a new action plan during this reporting period? Yes No If yes, please describe: _______________________________
Please report any notable accomplishments related to planning activities achieved during this reporting period: _____________________________________________________________________________________________________________ _____________________________________________________________________________________________________________
Please report any additional details, including barriers or challenges about your planning activities that were not captured above:_______________________________________________________________________________________________________ _____________________________________________________________________________________________________________
Summary of Effort: Coalition Processes
Approximately what percent of overall coalition effort went into each of the following processes? (Note: total should sum to 100%) ___% Assessment ___% Capacity ___% Planning ___% Implementation ___% Evaluation
Approximately what percent of overall coalition resources went into each of the following processes? (Note: total should sum to 100%) ___% Assessment ___% Capacity ___% Planning ___% Implementation ___% Evaluation

IMPLEMENTATION SECTION Implementation puts into motion the activities identified in the planning process. In this section, grantees will first rank their level of effort related to each of the seven strategies. Then, for each strategy, grantees will be asked to describe the types of activities engaged in during the reporting period.
Implementation Strategies During this Reporting Period . . .
Implementation Strategies (These categories apply to both capacity building in the community [supporting programs to do these things] as well as direct actions)	Rank the implementation strategies by the amount of your coalition's paid staff labor effort that was spent on each:	Rank the implementation strategies by the amount of your coalition members’ labor effort that was spent on each:	Rank the implementation strategies by the amount of your coalition's budget that was spent on each:
Providing Information (e.g., community education, increasing knowledge, raising awareness)	Drop down of ranks (1=Most Effort to 7=Least Effort), plus an Option for Not Applicable (no effort expended)	Drop down of ranks (1=Most Effort to 7=Least Effort), plus an Option for Not Applicable (no effort expended)	Drop down of ranks (1=Most Budget to 7=Least Budget), plus an Option for Not Applicable (no money expended)
Enhancing Skills (e.g., building skills and competencies)
Providing Support (e.g., increasing involvement in drug-free/healthy alternative activities)
Enhancing Access/Reducing Barriers (e.g., improving access, availability, and use of systems and service)
Changing Consequences (e.g., incentives/disincentives, increasing attention to enforcement and compliance)
Physical Design (e.g., improving environmental and structural signs and areas to support the initiative)
Modifying/Changing Policies (e.g., changing institutional or government policies)

Strategy Activity Details: Providing Information
Activities focused on providing information	Did your coalition work on this activity during this reporting period? (Note: Grantee will only complete rest of row for activities they indicate yes they worked on.)	Visible Only to STOP ACT Grantees Did Your coalition Use STOP Act funds to support the following new or advanced activities? (Note: Clicking on button will indicate yes, used STOP Act funds.)	Number of completed activities this period Grantee will fill in a number. Option to hover over cells for more information such as what is in cells below.)	Target Substance(s) Drop down: Alcohol, Tobacco, Marijuana, Prescription Drugs, Other Substance, No Substance Specified; Grantees may select multiple substances	How many people did this activity reach?		Sector(s) Contributing to This Activity Drop down: list of sectors, includes option for N/A: Paid Staff/ Volunteer Accomplishment	In your opinion, how successful was this effort? Drop down: (1) very successful; (2) moderately successful; (3) not successful
					Adults	Youth
Media campaigns: Television/Radio/Print/Billboards/Bus or other Posters	 Yes  No		Number of spots/ ads aired or placed this reporting period		Not applicable for this activity	Not applicable for this activity
Media coverage : TV / radio / newspaper stories	 Yes  No		Number of media stories appearing this reporting period		Not applicable for this activity	Not applicable for this activity
Informational materials prepared/ produced	 Yes  No		Number of press releases, brochures, flyers, posters, audiovisual products prepared/ produced during this reporting period		Not applicable for this activity	Not applicable for this activity
Informational materials disseminated	 Yes  No		Number of brochures, flyers, posters, audio visual products distributed during this reporting period
Social networking (Facebook, Twitter, etc.)	 Yes  No		Number of posts on social media sites during reporting period.		Facebook "Friends"; Twitter "Followers”	Facebook "Friends"; Twitter "Followers”
Information on DFC Coalition Web site	 Yes  No		Number of new materials posted during this reporting period.		Number of web hits (for this activity indicate total number of web hits in the number of adults column)	Not applicable for this activity
Direct, face-to-face information sessions	 Yes  No		Number of educational presentations, workshops, seminars, town hall meetings held during this reporting period by your coalition staff. Only include sessions intended to provide general information. Training sessions will be covered in the next topic.		Number of adults in audience	Number of youth in audience
Special events (e.g., fairs, community celebrations)	 Yes  No		Number of events that your coalition participated in during this reporting period. These events could be either run by your coalition, or your coalition could participate in them.		Approximate adult attendance at events	Approximate youth attendance at events
Other ( please specify ): (NOTE: Grantee able to add multiple “other” activity rows)
Indicate the average level of contribution that coalition paid/volunteer staff made to activities involving providing information:  Completely responsible for most activities  Typically does not take lead, but helps coalition members  Typically takes lead with help from coalition members  Minimally involved: coalition members take on most responsibilities

Strategy Activity Details: Enhancing Skills
Activities focused on enhancing skills	Did your coalition work on this activity during this reporting period? (Note: Grantee will only complete rest of row for activities they indicate yes they worked on.)	Visible Only to STOP ACT Grantees Did Your coalition Use STOP Act funds to support the following new or enhanced activities? (Note: Clicking on button will indicate yes, used STOP Act funds.)	Number of completed activities this period Grantee will fill in a number. Option to hover over cells for more information such as what is in cells below.)	Target Substance(s) Drop down: Alcohol, Tobacco, Marijuana, Prescription Drugs, Other Substance, No Substance Specified; Grantees may select multiple substances	How many people did this activity reach?		Sector(s) Contributing to This Activity Drop down: list of sectors, includes option for N/A: Paid Staff/ Volunteer Accomplishment	In your opinion, how successful was this effort? Drop down: (1) very successful; (2) moderately successful; (3) not successful
					Adults	Youth
Youth Education and Training Programs (providing Information / skills)	Yes No		Number of sessions delivered of programs focusing on information skills		Not applicable for this activity	Number of youth receiving training (do not double count if youth received more than one session)
Parent Education and Training Programs	Yes No		Number of training sessions on drug awareness, prevention strategies, parenting skills specifically for parents		Number of parents receiving training (do not double count if parent received more than one session)	Not applicable for this activity
Teacher/ Youth Worker Education and Training Programs	Yes No		Number of training sessions on drug awareness and prevention strategies specifically for teachers / Youth Workers		Number of teachers / youth workers trained (do not double count if participant received more than one session)	Not applicable for this activity
Community Member Education and Training Programs	Yes No		Number of training sessions on drug awareness and prevention strategies, cultural competence for community members, including law enforcement, media, and landlords		Number of community members trained (do not double count if community member received more than one session)	Not applicable for this activity
Business Training (e.g., responsible beverage service/ vendor training [voluntary or mandatory])	Yes No		Number of training sessions delivered on server compliance, training on youth marketed alcohol products, tobacco sales, etc.		Number of people trained (do not double count if participant received more than one session)	Not applicable for this activity
Other ( please specify ): (NOTE: Grantee will be able to add multiple other activity rows)	Yes No	
Indicate the average level of contribution that coalition paid/volunteer staff made to activities involving enhancing skills:  Completely responsible for most activities  Typically does not take lead, but helps coalition members  Typically takes lead with help from coalition members  Minimally involved: coalition members take on most responsibilities

Strategy Activity Details: Providing Support
Activities focused on providing support	Did your coalition work on this activity during this reporting period? (Note: Grantee will only complete rest of row for activities they indicate yes they worked on.)	Visible Only to STOP ACT Grantees Did Your coalition Use STOP Act funds to support the following new or enhanced activities? (Note: Clicking on button will indicate yes, used STOP Act funds.)	Number of completed activities this period Grantee will fill in a number. Option to hover over cells for more information such as what is in cells below.)	Target Substance(s) Drop down: Alcohol, Tobacco, Marijuana, Prescription Drugs, Other Substance, No Substance Specified; Grantees may select multiple substances	How many people did this activity reach?		Sector(s) Contributing to This Activity Drop down: list of sectors, includes option for N/A: Paid Staff/ Volunteer Accomplishment	In your opinion, how successful was this effort? Drop down: (1) very successful; (2) moderately successful; (3) not successful
					Adults	Youth
Alternative/drug-free social events	Yes No		Number of drug-free parties, other events supported by coalition		Number of attendees: Adults not part of coalition	Number of attendees: youth
Youth organizations/ drop-in centers	Yes No		Number of clubs (after-school or other) and centers supported by your coalition. "Support" can be in the form of financial, labor, or in-kind assistance.			Number of youth belonging to clubs or centers
Organized youth recreation programs (e.g., athletics, arts, outdoor activities)	Yes No		Number of events supported by your coalition: please do not include events that are designed specifically to provide information			Number of league participants
Youth/ family community involvement (e.g., school or neighborhood cleanup)	Yes No		Number of community involvement events held		Number of adult participants	Number of youth participants
Youth/family support groups	Yes No		Number of groups (e.g., leadership groups, mentoring programs, youth employment programs)		Number of adult participants	Number of student participants, including number of mentoring matches (do not double count if youth received more than one session, or if the youth participated in mentoring plus other programs)
Other ( please specify ): (NOTE: Grantee will be able to add multiple other activity rows) _____________	Yes No	
Indicate the average level of contribution that coalition paid/volunteer staff made to activities involving providing support:  Completely responsible for most activities  Typically takes the lead with help from coalition members  Typically does not take lead, but helps coalition members  Minimally involved: coalition members take on most responsibilities

Strategy Activity Details: Enhancing Access/Reducing Barriers
Activities focused on enhancing access / reducing barriers	Did your coalition work on this activity during this reporting period? (Note: Grantee will only complete rest of row for activities they indicate yes they worked on.)	Visible Only to STOP ACT Grantees Did Your coalition Use STOP Act funds to support the following new or enhanced activities? (Note: Clicking on button will indicate yes, used STOP Act funds.)	Target Substance(s) Drop down: Alcohol, Tobacco, Marijuana, Prescription Drugs, Other Substance, No Substance Specified; Grantees may select multiple substances	How many people did this activity reach?		Sector(s) Contributing to This Activity Drop down: list of sectors, includes option for N/A: Paid Staff/ Volunteer Accomplishment	In your opinion, how successful was this effort? Drop down: (1) very successful; (2) moderately successful; (3) not successful
				Adults	Youth
Increased Access to Substance Use Services (e.g., court mandated service, assessment and referral, EAP’s, SAP’s)	Yes No			Number of adults served, referred to treatment, involved in EAPs	Number of youth served, referred to treatment, involved in SAPs
Reducing Home and Social Access to Alcohol and Other Substances (e.g., prescription drug disposal)	Yes No			Number of adults participating in prescription drug takeback programs	Number of youth participating in prescription drug takeback programs
Improve supports for service use (e.g., transportation, child care)	Yes No			Number of adults served	Number of youth served
Improve access through culturally sensitive outreach (e.g., multilingual materials)	Yes No			Number of adults targeted (this may be double-counted with your entries for “Providing Information”	Number of youth targeted (this may be double-counted with your entries for “Providing Information”
Other (please specify): (NOTE: Grantee will be able to add multiple other activity rows) _____________	Yes No	
Indicate the average level of contribution that coalition paid/volunteer staff made to activities involving enhancing access/reducing barriers:  Completely responsible for most activities  Typically does not take lead, but helps coalition members  Typically takes lead with help from coalition members  Minimally involved: coalition members take on most responsibilities

Strategy Activity Details: Changing Consequences
Activities focused on changing consequences	Did your coalition work on this activity during this reporting period? (Note: Grantee will only complete rest of row for activities they indicate yes they worked on.)	Visible Only to STOP ACT Grantees Did your coalition use STOP Act funds to support the following new or enhanced activities?	Target Substance(s) Drop down: Alcohol, Tobacco, Marijuana, Prescription Drugs, Other Substance, No Substance Specified; Grantees may select multiple substances	How Many Businesses Did Each Activity Reach? Grantee will fill in a number. Option to hover over cells for more information such as what is in cells below.)	Sector(s) Contributing to This Activity Drop down: list of sectors, includes option for N/A: Paid Staff/ Volunteer Accomplishment	In your opinion, how successful was this effort? Drop down: (1) very successful; (2) moderately successful; (3) not successful
Strengthening Enforcement (e.g., supporting DUI checkpoints, shoulder tap programs, open container laws)	Yes No		Drop down: Alcohol, Tobacco, Marijuana, Prescription Drugs, Other Substance, Multiple/ Substances/No Substance Specified	Not applicable for this activity
Strengthening Surveillance (e.g., “hot spots,” party patrols)	Yes No			Not applicable for this activity
Recognition programs (e.g., programs for merchants who pass compliance checks, drug free youth)	Yes No			Number of businesses receiving recognition for compliance
Publicize Non-Compliance (e.g., advertisements highlighting businesses non-compliant with local ordinances)	Yes No			Number of businesses receiving recognition for non-compliance
Other (please specify ): (NOTE: Grantee will be able to add multiple other activity rows)	Yes No	
Indicate the average level of contribution that coalition paid/volunteer staff made to activities involving changing consequences:  Completely responsible for most activities  Typically does not take lead, but helps coalition members  Typically takes lead with help from coalition members  Minimally involved: coalition members take on most responsibilities

Strategy Activity Detail: Physical Design
Activities focused on physical design	Did your coalition work on this activity during this reporting period? (Note: Grantee will only complete rest of row for activities they indicate yes they worked on.)	Visible Only to STOP ACT Grantees Did Your coalition Use STOP Act funds to support the following? (Note: Clicking on button will indicate yes, used STOP Act funds.)	Number of completed activities this period Grantee will fill in a number. Option to hover over cells for more information such as what is in cells below.)	Target Substance(s) Drop down: Alcohol, Tobacco, Marijuana, Prescription Drugs, Other Substance, No Substance Specified; Grantees may select multiple substances	Sector(s) Contributing to This Activity Drop down: list of sectors, includes option for N/A: Paid Staff/ Volunteer Accomplishment	In your opinion, how successful was this effort? Drop down: (1) very successful; (2) moderately successful; (3) not successful
Identify Physical Design Problems (e.g., environmental scans, neighborhood meetings, windshield surveys)	Yes No		Number of physical design problems (e.g., hot spots, clean up areas, outlet clusters) identified this period.
Cleanup and Beautification (e.g., Improve parks and other physical landscapes, neighborhood clean-ups)	Yes No		Number of cleanup / beautification events held this period (e.g., neighborhood cleanup days)
Improve visibility/ ease of surveillance in public places and substance use hotspots (e.g., improved lighting, surveillance cameras, improved lines of sight)	Yes No		Number of areas (public places / hot spots) in which surveillance / visibility was improved this period.
Promote improved signage / advertising / practices by suppliers (e.g., Decrease signage/ advertising / change product locations)	Yes No		Number of suppliers making changes in signage / advertising / displays this period.
Identify problem establishments for closure (e.g., close drug houses)	Yes No		Number of problem establishments identified / targeted; Number closed / modified practices
Encourage business / supplier designation of “no alcohol” or “no tobacco” zones	Yes No		Number of businesses targeted / approached; number that made changes
Other ( please specify ): (NOTE: Grantee will be able to add multiple other activity rows) _____________	Yes No	
Indicate the average level of contribution that coalition paid/volunteer staff made to activities involving physical design:  Completely responsible for most activities  Typically does not take lead, but helps coalition members  Typically takes lead with help from coalition members  Minimally involved: coalition members take on most responsibilities

Strategy Activity Detail: Modifying/Changing Policies
Activities focused on Modifying / Changing Policies	Did your coalition work on this activity during this reporting period? (Note: Grantee will only complete rest of row for activities they indicate yes they worked on.)	Visible Only to STOP ACT Grantees Did Your coalition Use STOP Act funds to support the following new or enhanced activities? (Note: Clicking on button will indicate yes, used STOP Act funds.)	Number of Policies or Laws Promoted or Opposed by Your Coalition this Reporting Period Grantee will fill in a number. Option to hover over cells for more information such as what is in cells below.)	Number of Policies or Laws Passed/Modified During This Period (hover over cells for more information) Grantee will fill in a number. Option to hover over cells for more information such as what is in cells below.)	Target Substance(s) Drop down: Alcohol, Tobacco, Marijuana, Prescription Drugs, Other Substance, No Substance Specified; Grantees may select multiple substances	Sector(s) Contributing to This Activity Drop down: list of sectors, includes option for N/A: Paid Staff/ Volunteer Accomplishment	In your opinion, how successful was this effort? Drop down: (1) very successful; (2) moderately successful; (3) not successful
Cost: Laws/public policies concerning cost ( e.g., alcohol or tobacco tax, fees)	Yes No		Number of laws or policies concerning cost incentives promoted or opposed during this reporting period	Number of laws passed or modified -- and policies initiated this period
Underage Use: Laws/public policies targeting use, possession, or behavior under the influence for minors	Yes No		Number of laws or public policies supported / promoted by DFC coalition concerning underage use, possession, or behavior under the influence (e.g., underage consumption, false identification laws, blood alcohol concentration, graduated driver’s licenses, loss of driving privileges for alcohol violations by minors)	Number of laws passed or modified this period concerning underage use, possession, or behavior under the influence (e.g., underage consumption, false identification laws, blood alcohol concentration, graduated driver’s licenses, loss of driving privileges for alcohol violations by minors)
School: Policies promoting drug-free schools	Yes No		Number of laws or policies concerning drug-free schools promoted / supported by DFC coalition this period. Do not include policies focused on underage use/possession that were covered above.	Number of laws or policies concerning drug-free schools passed or modified during this period. Do not include policies focused on underage use/possession that were covered above
Treatment/ Prevention: Laws/ public policies promoting treatment or prevention alternatives (e.g., diversion treatment programs for underage substance use offenders)	Yes No		Number of laws or public policies concerning availability and sentencing alternatives to increase treatment / prevention promoted / supported by DFC coalition this period.	Number of laws/ policies passed or modified this period concerning availability and sentencing alternatives to increase treatment / prevention
Workplace: Policies promoting drug-free workplaces	Yes No		Number of laws or policies concerning drug-free workplaces promoted / supported by DFC coalition this period. Do not include policies mandating treatment.	Number of laws or policies concerning drug-free workplaces passed or modified during this period. Do not include policies mandating treatment.
Citizen enabling/Liability: Laws/ public policies concerning adult (including parent) social enabling or liability (e.g., social host ordinances)	Yes No		Number of laws or public policies concerning adult/parent social enabling or liability promoted/ supported by DFC coalition this period.	Number of laws passed or modified this period concerning parent/ social enabling /liability.
Supplier Promotion / Liability: Laws/ public policies concerning supplier advertising, promotion, liability, (e.g. server liability, product placement, happy hours, drink specials, mandatory compliance checks, responsible beverage service)	Yes No		Number of laws or public policies concerning supplier advertising, promotion, or liability promoted/supported by DFC coalition this period.	Number of laws passed or modified this period concerning supplier advertising, promotion, liability.
Outlet Location / Density: Laws/ public policies concerning limitation and restrictions of location and density of alcohol outlets	Yes No		Number of laws or zoning ordinances concerning density/ location of alcohol outlets promoted / supported by DFC coalition this reporting period.	Number of laws/zoning ordinances passed this period concerning the density of alcohol outlets
Sales Restrictions: Laws/ public policies concerning restrictions on product sales (e.g., methamphetamine pre-cursor access, alcohol at gas stations)	Yes No		Number of laws or public policies concerning restrictions on product sales promoted/ supported by DFC coalition this period.	Number of laws/ public policies concerning restrictions on product sales passed or modified this period.
Other ( please specify ): (NOTE: Grantee will be able to add multiple other activity rows) ____________	Yes No	
Indicate the average level of contribution that coalition paid/volunteer staff made to activities involving modifying/changing policies:  Completely responsible for most activities  Typically does not take lead, but helps coalition members  Typically takes lead with help from coalition members  Minimally involved: coalition members take on most responsibilities

Implementation Summary

In the last six months, did you coalition successfully modify/change any policies/laws?

If yes, briefly describe the policy/law, indicate the month and year the work to successfully modify/change the policy was completed and select the substance(s) targeted by the policy.

Policy 1: ___(open text field)_______________________________	Month/Year (select from dropdown)	Target Substance(s) Drop down: Alcohol, Tobacco, Marijuana, Prescription Drugs, Other Substance, No Substance Specified; Grantees may select multiple substances
Policy 2: _____________________________________________	Month/Year (select from dropdown)	Target Substance(s) Drop down: Alcohol, Tobacco, Marijuana, Prescription Drugs, Other Substance, No Substance Specified; Grantees may select multiple substances
Policy 3: _____________________________________________	Month/Year (select from dropdown)	Target Substance(s) Drop down: Alcohol, Tobacco, Marijuana, Prescription Drugs, Other Substance, No Substance Specified; Grantees may select multiple substances

Do you have any additional details, like accomplishments or challenges and barriers, related to implementation to report for this reporting period?

Please report any notable accomplishments related to implementation activities achieved during this reporting period?

Please report any additional details, including barriers or challenges, about your implementation activities that were not captured above:

Coalition Evaluation Effort
Approximately what percent of your coalition’s evaluation effort and resources went into the following activities? (Total must add to 100%):
___% Data collection ___% Data analysis ___% Identifying recommendations for improvement ___% Presenting evaluation findings ___% Other ( please specify ): _____________________

COMMUNITY AND POPULATION-LEVEL OUTCOMES Evaluation measures the quality and outcomes of coalition work Evaluation enables the improvement of interventions and coalition practices
Core Outcomes
Data Source (dropdown of coalition’s approved surveys)
Outcome Category this Data Applies To (select 30- day use, perception of risk, perception of parental or perception of peer) **repeat this for every APPROVED core measure**
Month and Year Data Were Collected: __/__
Compared to Target Area, the Geographical Area Covered by These Data Is: Larger Smaller The Same Don’t Know		Does your data represent your target population? Yes No If no, please explain:______________				Does your data represent the same grades and same schools that were surveyed in your last report? Yes No If no, please explain:_____________
Core Measures: Past 30-Day Use You must submit the survey used to collect the data that you are submitting in order to be able to submit core measure data. You will receive a survey review guide from the DFC National Evaluation team once their review of your survey is complete. Be sure to leave adequate time prior to core measure data submission to complete this step in the process. Surveys can be submitted at any time. Your survey review guide provides you with information on what data the grantee is expected to submit (which core measures have been approved for which substances) as well as guidance on how to calculate percentage use.
Grade	Measure			Alcohol	Tobacco		Marijuana	Prescription Drugs
6	30-day Use
	Sample Size
7	30-day Use
	Sample Size
8	30-day Use
	Sample Size
9	30-day Use
	Sample Size
10	30-day Use
	Sample Size
11	30-Day Use
	Sample Size
12	30-Day Use
	Sample Size
Middle School	30-Day Use
	Sample Size
High School	30-Day Use
	Sample Size
Gender	Measure			Alcohol	Tobacco		Marijuana	Prescription Drugs
Male	30-Day Use
	Sample Size
Female	30-Day Use
	Sample Size
Core Measures: Perception of Risk
Grade	Measure			Alcohol	Tobacco		Marijuana	Prescription Drugs
6	Perception of Risk
	Sample Size
7	Perception of Risk
	Sample Size
8	Perception of Risk
	Sample Size
9	Perception of Risk
	Sample Size
10	Perception of Risk
	Sample Size
11	Perception of Risk
	Sample Size
12	Perception of Risk
	Sample Size
Middle School	Perception of Risk
	Sample Size
High School	Perception of Risk
	Sample Size
Gender	Measure			Alcohol	Tobacco		Marijuana	Prescription Drugs
Male	Perception of Risk
	Sample Size
Female	Perception of Risk
	Sample Size
Core Measures: Perception of Peer Disapproval
Grade	Measure			Alcohol	Tobacco		Marijuana	Prescription Drugs
6	Perception of Peer Disapproval
	Sample Size
7	Perception of Peer Disapproval
	Sample Size
8	Perception of Peer Disapproval
	Sample Size
9	Perception of Peer Disapproval
	Sample Size
10	Perception of Peer Disapproval
	Sample Size
11	Perception of Peer Disapproval
	Sample Size
12	Perception of Peer Disapproval
	Sample Size
Middle School	Perception of Risk
	Sample Size
High School	Perception of Risk
	Sample Size
Gender	Measure			Alcohol	Tobacco		Marijuana	Prescription Drugs
Male	Perception of Peer Disapproval
	Sample Size
Female	Perception of Peer Disapproval
	Sample Size
Core Measures: Perception of Parental Disapproval
Grade	Measure			Alcohol	Tobacco		Marijuana	Prescription Drugs
6	Perception of Parental Disapproval
	Sample Size
7	Perception of Parental Disapproval
	Sample Size
8	Perception of Parental Disapproval
	Sample Size
9	Perception of Parental Disapproval
	Sample Size
10	Perception of Parental Disapproval
	Sample Size
11	Perception of Parental Disapproval
	Sample Size
12	Perception of Parental Disapproval
	Sample Size
Middle School	Perception of Risk
	Sample Size
High School	Perception of Risk
	Sample Size
Gender	Measure			Alcohol	Tobacco		Marijuana	Prescription Drugs
Male	Perception of Parental Disapproval
	Sample Size
Female	Perception of Parental Disapproval
	Sample Size

STOP ACT Core Measures: Perception of Risk (Regular Alcohol Use)
Grade	Measure	Regular Alcohol Use
6	Perception of Risk (Regular Alcohol Use)
	Sample Size
7	Perception of Risk (Regular Alcohol Use)
	Sample Size
8	Perception of Risk (Regular Alcohol Use)
	Sample Size
9	Perception of Risk (Regular Alcohol Use)
	Sample Size
10	Perception of Risk (Regular Alcohol Use)
	Sample Size
11	Perception of Risk (Regular Alcohol Use)
	Sample Size
12	Perception of Risk (Regular Alcohol Use)
	Sample Size
Middle School	Perception of Risk (Regular Alcohol Use)
	Sample Size
High School	Perception of Risk (Regular Alcohol Use)
	Sample Size
Gender	Measure	Alcohol
Male	Perception of Risk (Regular Alcohol Use)
	Sample Size
Female	Perception of Risk (Regular Alcohol Use)
	Sample Size
STOP ACT Core Measures: Attitude Toward Peer Use of Alcohol
Grade	Measure	Alcohol
6	Attitude Toward Peer Use of Alcohol
	Sample Size
7	Attitude Toward Peer Use of Alcohol
	Sample Size
8	Attitude Toward Peer Use of Alcohol
	Sample Size
9	Attitude Toward Peer Use of Alcohol
	Sample Size
10	Attitude Toward Peer Use of Alcohol
	Sample Size
11	Attitude Toward Peer Use of Alcohol
	Sample Size
12	Attitude Toward Peer Use of Alcohol
	Sample Size
Middle School	Perception of Risk (Regular Alcohol Use)
	Sample Size
High School	Perception of Risk (Regular Alcohol Use)
	Sample Size
Gender	Measure	Alcohol
Male	Attitude Toward Peer Use of Alcohol
	Sample Size
Female	Attitude Toward Peer Use of Alcohol
	Sample Size

Outcomes Summary

Are you collecting any other consequences? Optional section allows coalitions to enter their own core measures data on other substances. If you are collecting data particularly relative to change in substances other than the core substances, please share here.

Do you have any concerns about the quality of your data? Please explain.

• Yes  No

If yes, please explain:_______________________________

Please report any notable accomplishments related to evaluation achieved during this reporting period:

Please report any additional details, including barriers or challenges, about your evaluation activities that were not captured above

CHALLENGES AND TA
Challenges
To what extent has your coalition experienced challenges in the following area?	Significant Challenge 4		Some Challenge 3		A Little Challenge 2		No Challenge 1		Not Applicable 0
Increasing coalition membership and participation									
Building leadership capacity among coalition members									
Attaining an agreement among coalition members regarding goals, planned initiatives, etc.									
Developing/revising a framework/logic model of change									
Completing a SWOT (strengths, weaknesses, opportunities, and threats) analysis									
Collecting/analyzing data for assessment purposes									
Recruiting/engaging target populations (e.g., students) in substance abuse prevention initiatives									
Engaging key stakeholders (e.g., school personnel) in substance abuse prevention initiatives									
Engaging the general community in substance abuse prevention initiatives									
Planning/Executing substance abuse prevention initiatives									
Developing/Executing a media plan to draw attention to new drug threats									
Attaining funding for substance abuse prevention initiatives									
Collecting/Analyzing data for evaluation purposes									
Other (please specify): __________________________									
Other (please specify): __________________________									
Other (please specify): __________________________									
Training and Technical Assistance: Survey of Needs
Training and technical assistance (T&TA) areas		To what extent would your coalition benefit from T&TA in each of these areas?
		A Great Deal		Some		A Little		Not at All
Coalition and partnership development								
Coalition and partnership maintenance								
Community needs and resource assessment								
Goal and outcome development and assessment								
Effective problem solving within a group setting								
Develop a framework or model of change								
Leadership development								
Cultural competency								
Organizational management								
Strategic planning								
Developing substance abuse prevention initiatives								
Advocacy and policy development								
Grant writing								
Program evaluation								
Program/Initiative sustainability								
Other (please specify): __________________________								
Did your coalition provide any training or technical assistance to other community groups or organizations? Yes No If yes, please describe: