Form 1122-0021 Semi-annual progress report for the The Grants to Enhanc

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U.S. Department of Justice
Office on Violence Against Women
SEMI-ANNUAL PROGRESS REPORT FOR
Grants to Enhance Culturally and Linguistically Specific
Services for Victims of Domestic Violence, Dating Violence,
Sexual Assault, and Stalking Program
Brief Instructions: This form must be completed for each Grants to Enhance Culturally and Linguistically Specific
Services for Victims of Domestic Violence, Dating Violence, Sexual Assault, and Stalking Program (Culturally and Linguistically Specific Services Program) grant received. A grant administrator or coordinator must ensure that the form is fully
completed 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 engaged
in under this grant during the current reporting period. Sections B and E of this form must be completed by all
grantees. In section A, subsection A1 must be answered. In section C, subsection C3 must be answered. In section D,
and subsections A2, C1, C2, and C4-C7, grantees must answer an initial question about whether they engaged in certain
activities during the current reporting period. If the response is yes, then the grantee must complete that section or subsection. If the response is no, the rest of that section or subsection is skipped.
For example, if you are a victim services agency providing training and victim services with staff funded under this grant,
you would complete A1, A2, B, C1, C3, D, and E (and answer “no” in subsections C2 and C4-C7).
The activities of volunteers or interns should be reported if they were coordinated or supervised by Culturally and
Linguistically Specific Services Program-funded staff or if Culturally and Linguistically Specific Services Program funds
substantially supported their activities.
For further information on filling out this form, refer to the separate instructions which contain detailed definitions and
examples illustrating how questions should be answered.

Section A:
A1:
A2:
Section B:
Section C:
C1:
C2:
C3:
C4:
C5:
C6:
C7:
Section D:
Section E:

SECTION
General Information
Grant Information
Staff Information
Purpose Areas
Function Areas
Training
Community Education
Coordinated Community Response
Policies
Products
Public Awareness
System Improvement
Victim Services
Narrative

Page Number
1
1
4
5
6
6
10
13
16
18
20
22
24
33

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A1

GENERAL INFORMATION
Grant Information

All grantees must complete this subsection.

1.

Date of report

(format date with 6 digits - 01/31/09)

2.

Current reporting period

3.

Grantee name

4.

Grant number
(the federal grant number assigned to your Culturally and Linguistically Specific Services Program
grant)

5.

Type of lead agency/organization
(Check the one answer that best describes the type of agency/organization administering Culturally
and Linguistically Specific Services Program funds.)

✔ January 1-June 30

✔ July 1-December 31

(Year)

Culturally and linguistically specific community based program with domestic violence, dating
violence, sexual assault, and stalking expertise
Culturally and linguistically specific community based program with a partner agency having
domestic violence, dating violence, sexual assault, and stalking expertise
5a. Is this a faith-based organization?
Yes

No

5b. Is the partner agency a faith-based organization?
Yes
6.

No

Point of contact
(person responsible for the day-to-day coordination of the grant)
First name

MI

Last name

Agency/organization name
Address
City

State

Telephone

Facsimile

Zip code

E-mail
7.

Does this grant specifically address tribal populations?
(Check yes if your Culturally and Linguistically Specific Services Program 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.

Which culturally and linguistically specific populations do you serve?
(Check all that apply.)

African
American Indian or Alaska Native
Asian
Black or African American
D/deaf or hard of hearing
Gay, lesbian, bisexual, transgender, or intersex
Hispanic or Latino
Immigrants, refugees, or asylum seekers
Middle Eastern
Pacific Islander
Religious (specify):
Other (specify):

8a. Additional information
(Provide additional information about the culturally and linguistically specific populations served for example that the victims/survivors you are serving are Spanish-speaking from Guatemala, the
Dominican Republic, or Mexico; victims/survivors of sex trafficking from Thailand, Cambodia, or
Russia; Orthodox Jews.)

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9.

What percentage of your Culturally and Linguistically Specific Services Program funds was directed
to each of these areas?
(Report the area[s] addressed by your Culturally and Linguistically Specific Services Program grant
during the current reporting period and estimate the approximate percentage of funds [or resources]
used to address each area [consider education, training, victim services, etc.]. The grantee may
choose how to make this determination.)
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/survivor. The term domestic violence/
dating 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 or dating partner. Stalking is defined as engaging
in a course of conduct directed at a specific person that would cause a reasonable person to fear for his
or her safety or the safety of others, or suffer substantial emotional distress. (See separate instructions
for more complete definitions.)

Percentage of grant funds
Sexual assault
Domestic violence/dating violence
Stalking
TOTAL (must equal 100%)

0

10. What percentage of Culturally and Linguistically Specific Services Program funds were used for
prevention activities during the current reporting period?
11. What percentage of Culturally and Linguistically Specific Services Program funds were used for
providing culturally and linguistically specific services to children exposed to domestic violence,
dating violence, sexual assault, and/or stalking during the current reporting period?

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A2

Staff Information

Were your Culturally and Linguistically Specific Services Program funds used to fund staff positions
during the current reporting period?
Check yes if Culturally and Linguistically Specific Services Program grant funds were used to pay staff,
including part-time staff and contractors.
Yes—answer question 12
No—skip to section B
12. Staff
(Report the total number of full-time equivalent [FTE] staff funded by the Culturally and Linguistically
Specific Services Program grant during the current reporting period. Report staff by function(s)
performed, not by title or location. Include employees who are part time and/or only partially funded
with these grant funds as well as consultants/contractors. Report grant-funded overtime. If an
employee or contractor was employed or utilized for only a portion of the reporting period, prorate
appropriately. For example, if you hired a full-time advocate in October who was 100% funded with
Culturally and Linguistically Specific Services Program funds, you would report that as .5 FTEs. Report
all FTEs in decimals, not percentages. One FTE is equal to 1,040 hours – 40 hours per week multiplied
by 26 weeks. See separate instructions for examples of how to calculate and prorate FTEs.)

Staff

FTE(s)

Administrator (director, fiscal manager)
Attorney (does not include prosecutor)
Child care professional
Counselor (does not include financial counselor or employment counselor)
Legal advocate (does not include attorney or paralegal)
Outreach worker
Paralegal
Program coordinator (training coordinator, victim services coordinator, project
coordinator, contract coordinator, clinical coordinator, volunteer coordinator)
Support staff (bookkeeper, accountant, administrative assistant)
Trainer/educator
Translator/interpreter
Victim advocate (non-governmental, includes domestic violence, sexual assault,
and dual)
Other (specify):
TOTAL

0

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B

PURPOSE AREAS

All grantees must complete this section.

13. Statutory purpose areas
(Check all purpose areas that apply to activities supported with Culturally and Linguistically Specific
Services Program funds during the current reporting period.)
Check ALL
that apply

14p11

Purpose areas
To work with State and local governments and social service agencies to develop and
enhance effective strategies to provide culturally and linguistically specific services to victims
of domestic violence, dating violence, sexual assault, and stalking.
To increase communities’ capacity to provide culturally and linguistically specific resources
and support for victims of domestic violence, dating violence, sexual assault, and stalking
crimes and their families.
To strengthen criminal justice interventions, by providing training for law enforcement,
prosecution, courts, probation, and correctional facilities on culturally and linguistically
specific responses to domestic violence, dating violence, sexual assault, and stalking.
To enhance traditional services to victims of domestic violence, dating violence, sexual
assault, and stalking through the leadership of culturally and linguistically specific programs offering services to victims of domestic violence, dating violence, sexual assault, and
stalking.
To work in cooperation with the community to develop education and prevention strategies
highlighting culturally and linguistically specific issues and resources regarding victims of
domestic violence, dating violence, sexual assault, and stalking.
To provide culturally and linguistically specific programs for children exposed to domestic
violence, dating violence, sexual assault and stalking.
To provide culturally and linguistically specific resources and services that address the safety,
economic, housing, and workplace needs of victims of domestic violence, dating violence,
sexual assault, or stalking, including emergency assistance.
To examine the dynamics of culture and its impact on victimization and healing.

14. Program interest areas addressed by your grant
(In addition to the purpose areas identified above, the Culturally and Linguistically Specific Services
Program Solicitation may have encouraged several program interest areas. If your program addressed
any of these interest areas during the current reporting period, list them below.)

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C1

FUNCTION AREAS
Training

Were your Culturally and Linguistically Specific Services Program funds used for training during the
current reporting period?
Check yes if Culturally and Linguistically Specific Services Program-funded staff provided training, or if
Culturally and Linguistically Specific Services Program funds directly supported the training.
Yes—answer questions 15-18
No—skip to C2
For the purposes of this reporting form, training means providing information on sexual assault,
domestic violence, dating violence, and stalking that enables professionals to improve their response
to victims/survivors as it relates to their role in the system. Education means providing general
information that will increase public awareness of sexual assault, domestic violence, dating violence,
and stalking. In this subsection, report information on training activities. Education should be
reported in subsection C2.
15. Training events provided
(Report the total number of training events that were either provided by Culturally and Linguistically
Specific Services Program-funded staff or directly supported by Culturally and Linguistically Specific
Services Program funds. Training provided to Culturally and Linguistically Specific Services Program
funded staff should not be counted.)
Total number of training events provided
16. Number of people trained
(Report the number of people trained during the current reporting period by Culturally and Linguistically
Specific Services Program-funded staff or training supported by Culturally and Linguistically Specific
Services Program funds. Use the category that is most descriptive of the people who attended the training event. Culturally and Linguistically Specific Services Program-funded staff attending training should
not be counted. If you do not know how many people to report in specific categories, you may report the
overall number in “Multidisciplinary,” but this category should be used only as a last resort. Students,
community members, and victims should not be reported as people trained, since they are not
professionals responding to victims.)

People trained

Number

Advocacy organization staff (NAACP, LGBTQ organization)
Attorneys/law students
Batterer’s intervention program staff
Child care staff
Child protective service workers
Children’s advocates (not affiliated with CPS)
Corrections personnel (probation, parole, and correctional facilities)
Court personnel (judges, clerks)
Culturally and linguistically specific organization staff (non-governmental, does not
include immigrant organization staff)
Deaf organization staff
Disability organization staff (non-governmental, non-residential)

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16. Number of people trained (cont.)

People trained

Number

Disability rights organization staff (P&A, UCP, NAMI)
Educators (teachers, administrators, etc.)
Faith/spiritual-based organization staff
Government agency staff (ICE, food stamps, TANF)
Health professionals (doctors, nurses—does not include SAFE/SANE)
Immigrant organization staff (non-governmental)
Interpreters/translators
Job training program staff (vocational rehabilitation, occupational training)
Law enforcement officers
Legal services staff (does not include attorneys)
Mental health professionals
Military command staff
Multidisciplinary (various disciplines at same training)
Prosecutors
Sexual assault forensic examiners/sexual assault nurse examiners (SAFE/SANE)
Social service organization staff (non-governmental—food bank, homeless shelter)
State or tribal coalition staff (includes sexual assault, domestic violence, and dual)
Substance abuse service providers
Supervised visitation and exchange center staff
Tribal government/Tribal government agency staff
Victim advocates (non-governmental, includes sexual assault, domestic violence,
and dual)
Victim assistants (governmental, includes victim-witness specialists/coordinators)
Volunteers
Other (specify):
TOTAL

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17. Training content areas
(Indicate all topics covered in training events provided or directly supported by your Culturally and Linguistically Specific Services Program funds during the current reporting period. Check all that apply.)
Sexual assault, domestic violence, dating violence, and stalking
Advocate response

Immigration issues

Barriers in accessing support services

Pro-arrest policies

Child development
Child witnesses

Protection orders (including full faith and
credit)

Confidentiality

Sexual assault forensic examination

Cultural issues

Use of technology (including TTY, ALD, and
relay services)

Dating violence overview, dynamics, and services
Domestic violence overview, dynamics,
and services
Immigration issues
Mandatory reporting requirements

Working with interpreters/translators
Working with victims/survivors with limited
English proficiency
Other (specify):

Parenting issues

Underserved populations
Response to secondary victims of sexual assault, domestic
Issues specific to victims/survivors who:
violence/dating violence, and/or stalking
are American Indian or Alaska Native
Response to victims/survivors who are incarcerated
are Asian
Response to victims/survivors who have been trafficked
are Black or African American
Safety planning for victims/survivors
are D/deaf or hard of hearing
Sexual assault overview, dynamics, and services
are elderly
Stalking overview, dynamics, and services
are geographically isolated
Working with interpreters/translators
are Hispanic or Latino
Working with victims/survivors with limited English
are homeless or living in poverty
proficiency
Other (specify):
Justice system
Barriers in accessing justice system
Building relationships with community service providers
Criminal convictions and immigration status
Cultural issues
Culturally and linguistically appropriate judicial response
Culturally and linguistically appropriate law
enforcement response
Culturally and linguistically appropriate probation
response
Culturally and linguistically appropriate prosecution
response
Hazards of using child as interpreter

are immigrants, refugees, or asylum seekers
are lesbian, gay, bisexual, transgender, or
intersex
are Pacific Islander
have disabilities
have limited English proficiency
have mental health issues
have substance abuse issues
Other (specify):
Community response
Community response to sexual assault
Coordinated community response
Community engagement
Other (specify):

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18. (Optional) Additional information
(Use the space below to discuss the effectiveness of training activities funded or supported by your
Culturally and Linguistically Specific Services Program grant and to provide any additional information
you would like to share about your training activities beyond what you have provided in the data above.
Examples might include improved understanding of the impact of arrests and criminal convictions on
immigration status following a training provided to law enforcement officers, or increased use of qualified, neutral interpreters following a multidisciplinary training provided to advocates, law enforcement,
and prosecution agencies.) (Maximum - 2000 characters)

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)

C2

Community Education

Were your Culturally and Linguistically Specific Services Program funds used for community education
during the current reporting period?
Check yes if Culturally and Linguistically Specific Services Program-funded staff engaged in community
education activities, or if Culturally and Linguistically Specific Services Program funds directly supported
community education.
Yes—answer questions 19-22
No—skip to C3
For the purposes of this reporting form, education means providing general information that will increase public awareness of sexual assault, domestic violence, dating violence, and stalking. Training
means providing information on sexual assault, domestic violence, dating violence, and stalking that
enables professionals to improve their response to victims/survivors as it relates to their role in the
system. In this subsection, report information on community education activities. Training should be
reported in subsection C1.
19. Education events provided
(Report the total number of education events provided during the current reporting period that were
either provided by Culturally and Linguistically Specific Services Program-funded staff or directly supported with Culturally and Linguistically Specific Services Program funds.)
Total number of education events provided
20. Number of people educated
(Report the number of people attending Culturally and Linguistically Specific Services Program-funded
community education events during the current reporting period. Use the category that is most descriptive of the people who attended the event.)
People attending event
Child care providers
Community advocacy groups (NAACP, AARP)
Community businesses (retail stores, pharmacies)
Community groups (service or social groups)
Community members (unaffiliated adults)
Educators (teachers, administrators, etc.)
Elementary school students
Faith-based groups
Middle and high school students
Parents or guardians
Religious/community leaders
University or college students
Victims/survivors (do not count psychoeducation groups)
Other (specify):
TOTAL

Number

0

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21. Topics of education events
(Indicate all topics covered in education events provided with your Culturally and Linguistically Specific
Services Program funds during the current reporting period. Check all that apply.)
Sexual assault, domestic violence, dating violence,
Underserved populations
and stalking
Issues specific to victims/survivors who:
Barriers in accessing support services
are American Indian or Alaska Native
Child witness overview, dynamics, and services
are Asian
Cross-cultural competence
are Black or African American
Cultural issues
are D/deaf or hard of hearing
Culturally and linguistically specific prevention
are elderly
programs
are geographically isolated
Dating violence overview, dynamics, and services
are Hispanic or Latino
Domestic violence overview, dynamics, and
are homeless or living in poverty
services
are immigrants, refugees, or asylum
Healthy relationships/domestic violence/dating
seekers
violence prevention (6-12th grade)
are lesbian, gay, bisexual, transgender,
Healthy relationships/domestic violence/dating
or intersex
violence prevention (community)
are Pacific Islander
Healthy relationships/domestic violence/dating
have disabilities
violence prevention (university)
have limited English proficiency
Immigration issues
have mental health issues
Parent-child interaction (parent-child play
program, parent-child music class)
have substance abuse issues
Parenting skills (child development, appropriate
Other (specify):
interventions)
Safety planning for victims/survivors
Secondary victims of sexual assault, domestic
violence/dating violence, and/or stalking overview,
dynamics, and services
Sexual assault overview, dynamics, and services
Sexual violence prevention
Stalking overview, dynamics, and services
Workplace violence
Other (specify):

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22. (Optional) Additional information
(Use the space below to discuss the effectiveness of education activities funded or supported by your
Culturally and Linguistically Specific Services Program grant and to provide any additional information you would like to share about your education activities beyond what you have provided in the data
above. Examples might include improved understanding of available services regardless of immigration status, and increased commitment to cultural and linguistic competency as a result of a presentation to community business leaders.) (Maximum - 2000 characters)

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C3

Coordinated Community Response
All grantees must complete this subsection.

23. Coordinated community response activities
(Check the appropriate boxes to indicate the agencies or organizations, even if they are not partners
with which you have a memorandum of understanding [MOU], that you provided victim/survivor referrals to, received victim/survivor referrals from, engaged in consultation with, provided technical
assistance to, and/or attended meetings with, during the current reporting period, according to the
usual frequency of the interactions. If the interactions were not part of a regular schedule, you will
need to estimate the frequency with which these interactions occurred during the current reporting
period. In the last column, indicate the agencies or organizations with which you have an MOU for purposes of the Culturally and Linguistically Specific Services Program grant. If Culturally and Linguistically
Specific Services Program-funded staff participated in a task force or work group, indicate that under
“Meetings” by checking the frequency of the meeting and the types of organizations participating.)
Agency/organization

Victim/survivor referrals,
Meetings
MOU
consultations, technical assistance
partner
Daily
Weekly
Monthly
Weekly Monthly Quarterly

Advocacy organization
(NAACP, LGBTQ organization)
Batterer intervention
program
Child protective services
Children’s advocacy
program
Corrections (probation,
parole, and correctional
facilities)
Court
Culturally and linguistically
specific organization
(non-governmental, does
not include immigrant
organization)
Deaf organization
Disability organization (nongovernmental,
non-residential)
Disability rights organization (P&A, UCP, NAMI)
Domestic violence program
Dual sexual assault and
domestic violence program
Educational institution/
organization
Faith/spiritual-based
organization
Government agency (ICE,
food stamps, TANF)
Health/mental health
organization
Immigrant organization
(non-governmental)
Law enforcement agency

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23. Coordinated community response activities (cont.)
Agency/organization

Victim/survivor referrals,
Meetings
MOU
consultations, technical assistance
partner
Daily
Weekly
Monthly
Weekly Monthly Quarterly

Legal organization (legal
services, bar associations,
law school)
Prosecutor’s office
Sexual assault program
Sex offender management/
sex offender treatment
provider
Social service organization
(non-governmental)
Supervised visitation and
exchange center
Translation/interpretation
organization
Tribal government/Tribal
government agency
Other (specify):

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24. (Optional) Additional information
(Use the space below to discuss the effectiveness of coordinated community [CCR] response activities
funded or supported by your Culturally and Linguistically Specific Services Program grant and to provide any additional information you would like to share about your CCR activities beyond what you have
provided in the data above. Examples might include improved understanding of cross cultural and
immigration issues in the community following meetings of a task force that included victim advocates,
legal services attorneys, law enforcement officers and prosecutors; or greater coordination between
the prosecutor’s office and the community-based service providers as a result of meetings with
governmental and non-governmental advocates.) (Maximum - 2000 characters)

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C4

Policies

Were your Culturally and Linguistically Specific Services Program funds used to develop, substantially
revise, or implement policies or protocols during the current reporting period?
Check yes if Culturally and Linguistically Specific Services Program-funded staff developed, substantially
revised, or implemented policies or protocols, or if Culturally and Linguistically Specific Services Program
funds directly supported the development, revision, and/or implementation of policies or protocols.
Yes—answer questions 25-26
No—skip to C5
25. Types of protocols or policies developed, substantially revised, and/or implemented during the current
reporting period
(Check all that apply.)
Victim services
Access to translators/interpreters
Appropriate use of translators/interpreters
Confidentiality
Culturally and linguistically appropriate response to underserved populations
Mandatory cross-training between community organizations
Other (specify):
Justice system
Access to translators/interpreters
Appropriate use of translators/interpreters
Culturally and linguistically appropriate response to underserved populations
Dedicated domestic violence docket
Full faith and credit for protection orders
Immediate access to obtaining protection orders
Immediate access to protection order information
Mandatory training on domestic violence/dating violence, sexual assault, and/or stalking
Policies to protect victims/survivors from internet disclosure of identifying information
Procedures for anonymous, confidential, or Jane Doe reporting of sexual assault
Providing information to victims/survivors about victim services
Sexual assault response and protocols
Standard protection order
Strategies to assist and protect victim/survivor during probation and parole
U visa certification
Victim-witness notification
Other (specify):
Health care
Access to translators/interpreters
Appropriate use of translators/interpreters
Culturally and linguistically appropriate response to underserved populations
Documentation
Mandatory training on sexual assault, domestic violence/dating violence, and/or stalking
Routine screening for sexual assault, domestic violence/dating violence, and/or stalking, and
referrals for culturally and linguistically appropriate services
Other (specify):

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26. (Optional) Additional information
(Use the space below to discuss the effectiveness of policies you have developed or implemented that
were funded or supported by your Culturally and Linguistically Specific Services Program grant and to
provide any additional information you would like to share about your activities related to the developing, revising, or implementing of policies beyond what you have provided in the data above. Examples
might include improved law enforcement response following implementation of a protocol for interpretation which provides officers/employees with detailed information about the use of language assistance services in handling situations involving individuals with limited English proficiency; or working
with project partners to ensure that their organizations’ policies are responsive to the needs of D/deaf
victims/survivors.) (Maximum - 2000 characters)

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C5

Products

Were your Culturally and Linguistically Specific Services Program funds used to develop, substantially
revise, or distribute products during the current reporting period?
Check yes if Culturally and Linguistically Specific Services Program-funded staff developed, revised,
and/or distributed products or if Culturally and Linguistically Specific Services Program funds directly
supported the development, substantial revision, or distribution of products.
Yes—answer question 27
No—skip to C6
27. Use of Culturally and Linguistically Specific Services Program funds for product development, substantial revision, and/or distribution
(Report the number of products developed, substantially revised, or distributed with Culturally and Linguistically Specific Services Program funds during the current reporting period. Report the number of new products/materials developed or substantially revised during the current reporting period; the title/topic and
intended audience of each product developed, revised, and/or distributed; and the number of products used
or distributed. If a product was created in or translated into a language other than English, including Braille,
indicate the language. Report on products that were newly developed during the current reporting period,
whether or not they were used or distributed during the current reporting period. Do not report the number
of products printed or copied; only report the number developed or revised—in most cases that number will
be one for each product described and/or the number used or distributed. See separate instructions for examples of how to report under “developed or revised” and “used or distributed.”)
Products

Number
developed or
revised

Title/topic

Intended
audience

Number
used or
distributed

Other
languages

Brochures

Manuals

Newsletter

Posters

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27. Use of Culturally and Linguistically Specific Services Program funds for product development,
substantial revision, and/or distribution
Products

Number
developed
or revised

Title/topic

Intended
audience

Number
used or
distributed

Other
languages

Public
service announcements

Training
curricula

Training
materials

Videos

Website
(report
number of
page views
in the used
or distributed
column)

Other
(specify):

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C6

Public Awareness

Were your Culturally and Linguistically Specific Services Program funds used for public awareness
activities during the current reporting period?
Check yes if Culturally and Linguistically Specific Services Program-funded staff engaged in public
awareness activities, or if Culturally and Linguistically Specific Services Program funds were used to
directly support public awareness activities.
Yes—answer questions 28-29
No—skip to C7
28. Public awareness activities
(Indicate the activities that were supported with Culturally and Linguistically Specific Services Program funds
during the current reporting period. Indicate by checking the appropriate box[es] whether the focus of the
activity was sexual assault, domestic violence, dating violence, stalking, or a combination of those issues.
Check all that apply.)
audience
Activities

Sexual assault

Domestic
violence/dating
violence

Stalking

Community organizing/community events (rallies,
speak outs, Take Back the Night, vigils)
Educational exhibits (Clothesline Project, Silent
Witness, information tables)
Media campaigns (press conferences, public service
announcements, articles)
Productions for public awareness (video series,
theater productions)
Other (specify):

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29. (Optional) Additional information
(Use the space below to discuss the effectiveness of public awareness activities funded or supported
by your Culturally and Linguistically Specific Services Program grant and to provide any additional information you would like to share about your activities beyond what you have provided in the data above.
An example might include conducting community events in languages most frequently encountered
in the population served to inform about the available services, resulting in building relationships between the communities and service providers.) (Maximum - 2000 characters)

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C7

System Improvement

Were your Culturally and Linguistically Specific Services Program funds used for system improvement
during the current reporting period?
Check yes if Culturally and Linguistically Specific Services Program-funded staff engaged in system improvement activities, or if Culturally and Linguistically Specific Services Program funds directly supported system
improvements (e.g., interpreters, safety audits, security).

Yes—answer questions 30-31
No—skip to section D
30. Use of Culturally and Linguistically Specific Services Program funds for system improvement
(Check all that apply.)

Victim services

Law enforcement

Prosecution

Court

Probation or parole

Evaluation
Facilitating community task force
Interpreters
Language lines
Meetings between
tribal and non-tribal
entities
Safety audits
Security personnel
or equipment
Translation of forms
and documents
Other (specify):

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31. (Optional) Additional information
(Use the space below to discuss the effectiveness of system improvement activities funded or supported by your Culturally and Linguistically Specific Services Program grant and to provide any additional
information you would like to share about your activities beyond what you have provided in the data
above. An example might include improved judicial response in cases involving individuals with limited
English proficiency as a result of translating all documents sent to victims and perpetrators into the
appropriate language.) (Maximum - 2000 characters)

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D

VICTIM SERVICES

Were your Culturally and Linguistically Specific Services Program funds used to provide victim services
to victims/survivors during the current reporting period?
Check yes if Culturally and Linguistically Specific Services Program-funded staff provided victim
services, or if Culturally and Linguistically Specific Services Program funds were used to support victim
services during the current reporting period.
Yes—answer questions 32-41
No—skip to section E
32. Number of primary victims/survivors served, partially served, and victims/survivors seeking services who were not served
Please do not answer this question without referring to the separate instructions for further explanation
and examples of how to distinguish among these categories. (Report the following, to the best of your
ability, as an unduplicated count for each category during the current reporting period. This means that
each victim/survivor who was seeking or who received services during the current reporting period
should be counted only once in that reporting period. For purposes of this question, victims/survivors
are those against whom the sexual assault, domestic violence, dating violence, and/or stalking was directed. If the victim/survivor presented with more than one victimization, that person should be counted only once under the primary victimization. Do not report secondary victims here.)
Sexual Domestic violence/
Stalking TOTAL
assault
dating violence
A. Served: Victims/survivors who received the
grant- funded service(s) they requested, if those
0
services were funded by your Culturally and
Linguistically Specific Services Program grant
B. Partially served: Victims/survivors who
received some grant-funded service(s), but not
0
all of the grant-funded services they requested, if
those services were funded by your Culturally and
Linguistically Specific Services Program grant
TOTAL SERVED AND PARTIALLY SERVED
0
0
0
0
(32A + 32B)
C. Victims/survivors seeking services who
were not served: Victims/survivors who sought
grant-funded service(s) and did not receive the
0
grant-funded services they were seeking, if those
services were funded by your Culturally and
Linguistically Specific Services Program grant
33. Number of secondary victims served Please do not answer this question without referring to the separate instructions for further explanation and for examples of how and when to report secondary victims.
(Report the following, to the best of your ability, as an unduplicated count for each category during
the current reporting period. This means that each secondary victim who received services during the
current reporting period should be counted only once and in only one of the listed categories, which
should correspond to the category of victimization of the primary victim. For purposes of this question,
secondary victims are those who are indirectly affected by the domestic violence, dating violence, sexual assault, and/or stalking - i.e., children, siblings, spouses or intimate partners, grandparents, other
affected relatives, friends, neighbors, etc.)
Sexual Domestic violence/
Secondary victims
Stalking TOTAL
assault
dating violence
Secondary victims who received service(s)
0
funded by your Culturally and Linguistically
Specific Services Program grant

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34. Reasons that the primary victims/survivors seeking services were not served or were partially served
(Check all that apply.)

Reasons not served or partially served
Conflict of interest
Did not meet statutory requirements
Hours of operation
Insufficient/lack of culturally and linguistically appropriate services
Insufficient/lack of language capacity (including sign language)
Insufficient/lack of services for victims/survivors who are D/deaf or hard of hearing
Insufficient/lack of services for victims/survivors with disabilities
Lack of child care
Program reached capacity
Program rules not acceptable to victim/survivor
Program unable to provide service due to limited resources/priority-setting
Services inappropriate or inadequate for victims/survivors with mental health issues
Services inappropriate or inadequate for victims/survivors with substance abuse issues
Services not appropriate for victim/survivor
Services not available for victims/survivors accompanied by male adolescents
Transportation
Other (specify):

[for developers: If a grantee enters a reason in “other” the following will pop up: “Victim declined
services,” “victim did not complete program,” and “victim could not be contacted” are all inappropriate
reasons and should not be reported in the “other” category. They indicate a misunderstanding of when
to report victims as partially served or not served. Please refer to the separate instructions for further
explanations and for examples.]

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35. Demographics of primary victims/survivors served or partially served

(Based on the primary victims/survivors reported in 32A and32B, provide the total numbers for all that apply. Because victims/survivors may identify in more than one category of race/ethnicity, the total for “Race/
ethnicity” may exceed the total number of victims/survivors reported in questions 32A and 32B. However,
the total number of victims/survivors reported under “Race/ethnicity” should not be less than the total number of victims/survivors reported in questions 32A and 32B. The total number of victims/survivors reported
under “Gender” and the total number reported under “Age” should equal the total number of victims/survivors reported in questions 32A and 32B. Those victims/survivors for whom gender, age, and/or
race/ethnicity is not known should be reported in the “Unknown” category. Do not report demographics for
secondary victims.)

Race/ethnicity (Victims/survivors should be counted once in each category
of race/ethnicity that applies. Victims/survivors should not be counted more
than once in either the category “American Indian or Alaska Native” or in the
category “Native Hawaiian or other Pacific Islander.”)

Number of
victims/survivors

American Indian or Alaska Native
Asian
Black or African American
Hispanic or Latino
Native Hawaiian or other Pacific Islander
White
Unknown
TOTAL RACE/ETHNICITY (should not be less than 0, the sum of 32A and 32B.)
Gender

0

Number of
victims/survivors

Female
Male
Unknown
TOTAL GENDER (should equal 0, the sum of 32A and 32B.)
Age

0

Number of
victims/survivors

0-12
13-17
18-24
25-59
60+
Unknown
TOTAL AGE (should equal 0, the sum of 32A and 32B.)
Other demographics

0

Number of
victims/survivors

People with disabilities
People who are D/deaf or hard of hearing
People with limited English proficiency
People who are immigrants/refugees/asylum seekers
People who live in rural areas

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36. Victims/survivors’ relationships to offender by victimization

(For
those victims/survivors reported as served and partially served in 32A and 32B, report the victim/
(For those victims/survivors reported as served and partially served in 32A and 32B, report the victim/
survivor’s
relationship to the offender by type of victimization. If a victim/survivor experienced more than
survivor’s relationship to the offender by type of victimization. If a victim/survivor experienced more
one
type
of
victimization and/or was victimized by more than one perpetrator, count the victim/survivor in
than one type of victimization and/or was victimized by more than one perpetrator, count the
all
categories that
The totalthat
number
relationships
in the
assaultincolumn
mustassault
be at least
victim/survivor
in apply.
all categories
apply.ofThe
total number
of sexual
relationships
the sexual
[insert
sum
of
sexual
assault
victims
reported
in
32A
and
32B];
the
total
number
in
the
domestic
column must be at least 0; the total number in the domestic violence/ dating violence column violence/
must be
dating
column
must be
at least
[insert
sum of
domestic
violence/dating
violence
victims/survivors
at leastviolence
0; the total
number
in the
stalking
column
must
be at least
0. Do not report
relationships
to
reported
32A
and 32B];victims.)
the total number in the stalking column must be at least [insert sum of stalking
offendersinfor
secondary
victims reported in 29A and 29B]. Do not report relationships to offenders for secondary victims.) Number of victim/survivor relationships by victimization
Number of victim/survivor relationships by victimization
Victim/survivor’s relationship to offender

Current or former spouse or intimate partner
Other family or household member
Current or former dating relationship
Acquaintance (neighbor, employee,
co-worker, student, schoolmate etc.)
Stranger
Relationship unknown
TOTAL

Domestic violence/
dating violence

Sexual
assault

0

Stalking

0

0

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37A. Victim services

(Report
32A
and
32B
who
received
Culturally
andand
Linguistically
(Reportthe
thenumber
numberofofvictims/survivors
victims/survivorsfrom
from
32A
and
32B
who
received
Culturally
Linguistically
Specifi
c
Services
Program-funded
services
during
the
current
reporting
period.
Count
each
victim/
Specific Services Program-funded services during the current reporting period. Count each
victim/
survivor
ofof
service
that
victim/survivor
received
during
the the
current
reporting
period;
survivoronly
onlyonce
oncefor
foreach
eachtype
type
service
that
victim/survivor
received
during
current
reporting
do
not report
thereport
number
times that
service
was
provided
the victim/survivor.
The total forThe
each
type
period;
do not
theof
number
of times
that
service
wastoprovided
to the victim/survivor.
total
of
service
should
not
be
higher
than
[insert
total
of
32A
and
32B],
the
total
of
32A
and
32B.
Shelter
for each type of service should not be higher than 0, the total of 32A and 32B. Shelter services should
services
should
be reported
in question
37C. secondary
Do not report
secondary
victims
receiving
services
in this
be reported
in question
37C.
Do not report
victims
receiving
services
in this
question.)
question.)

Type of service

Number of victims/
survivors
served

Civil legal advocacy/court accompaniment (Assisting a victim/survivor with civil
legal issues including preparing paperwork for a protection order and accompanying victim/survivor to a protection order hearing, administrative hearing, or other
civil court proceeding. Does not include advocacy by attorneys and/or paralegals.)
Civil legal assistance (Civil legal services provided by an attorney and/or a
paralegal)
Counseling services/support group (Individual or group counseling or support
provided by a volunteer, peer, or professional)
Criminal justice advocacy/court accompaniment (Assisting a victim/survivor with
criminal legal issues, including notifying the victim/survivor of case status,
hearing dates, plea agreements, and sentencing terms; preparing paperwork
such as victim impact statements; accompanying a victim/survivor to a criminal
court proceeding or law enforcement interview; and all other advocacy within the
criminal justice system)
Crisis intervention (Crisis intervention is a process by which a person identifies,
assesses, and intervenes with an individual in crisis so as to restore balance and
reduce the effects of the crisis in her/his life. In this category, report crisis
intervention that occurs in person and/or over the telephone.)
Employment counseling (Actions designed to assist a victim/survivor in obtaining employment, e.g., coaching on career options, skills training, job searches,
resume-writing, marketing, job interviews, and preservation of employment)
Financial counseling (Actions designed to assist a victim/survivor with issues
related to improving credit, retiring debt, setting up bank accounts, managing
household finances, negotiating with lenders or landlords, developing budgets,
managing financial assets, making major purchases such as a home or auto,
filing tax returns, etc.)
Hospital/clinic/other medical response (Accompanying a victim/survivor to, or
meeting a victim/survivor at a hospital, clinic, or medical office)
Job training (Providing training in specific employment-related skills to a victim/
survivor, e.g., on computer literacy)
Language services (Interpretation, translation)
Material assistance (Providing victims/survivors with clothing, food, personal
items, etc.)
Transportation (Providing of transportation, either directly or through bus passes,
taxi fares, or other means of transportation)
Victim/survivor advocacy (Actions designed to help the victim/survivor obtain
needed support, resources, or services including employment, housing, shelter
services, health care, victims’ compensation, school/education, etc.)
Other (specify):

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37B. Immigration matters

(For
services
in in
question
37A,
report
thethe
number
whowho
(For the
the victims/survivors
victims/survivorsreported
reportedas
asreceiving
receivingvictim
victim
services
question
37A,
report
number
received
assistance
with
immigration
matters
during
the
current
reporting
period.
In
the
row
marked
received assistance with immigration matters during the current reporting period. In the row marked
“Immigration
provide an
assistance
any
“immigration matters,”
matters,”provide
an unduplicated
unduplicatedcount
countof
ofvictims/survivors
victims/survivorswho
whoreceived
received
assistancewith
with
immigration
issue,issue,
even even
if theyifreceived
help with
issue
received
assistance
on moreonthan
any immigration
they received
helpmore
withthan
moreone
than
oneorissue
or received
assistance
one
specificFor
categories
immigration
matters, report
the number
who
moreoccasion.
than oneFor
occasion.
specific of
categories
of immigration
matters,
report of
thevictims/survivors
number of
received
assistance
in
each
of
the
categories.
Count
a
victim/survivor
only
once
for
each
immigration
victims/survivors who received assistance in each of the categories. Count a victim/survivor only once
matter
forimmigration
which they received
assistance.
numberassistance.
of victims/survivors
reported
in any category should
for each
matter for
which theyThe
received
The number
of victims/survivors
not
be greater
[insertshould
sum ofnot
32Abe+ greater
32B], the
sum
of 32A
and
reported
in anythan
category
than
0,the
sum
of 32B.)
32A and 32B.)

Number of
victims/survivors

Immigration matters addressed
Immigration matters (Unduplicated count of victims/survivors receiving assistance in one or more of the categories below - do not add categories together)
VAWA self-petition
Cancellation of removal
Work authorization
U visa
T visa
Other immigration matters (specify):

37C. Shelter services

(Report the total number of victims/survivors and accompanying family members who received emergency
shelter and/or transitional housing provided with Culturally and Linguistically Specific Services Program
funds during the current reporting period. This should be an unduplicated count for both victims/survivors
and for family members. This means that each victim/survivor and each family member who received shelter services during the current reporting period should be counted only once. Report the total number of bed
nights provided in emergency shelter and/or transitional housing to victims/survivors and family members.
The number of bed nights is computed by multiplying the number of victims/survivors and family members
by the number of nights they stayed in the shelter. The number of bed nights will typically be significantly
higher than the number of victims/survivors and family members. For example, one victim/survivor and her
three children all stayed in the shelter for 10 nights. The number of bed nights would be 4 multiplied by 10,
or 40.)

Shelter service

Number of victims/
survivors

Number of family
members (include all
children here)

Number of
bed nights

Emergency shelter
Transitional housing

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38. Hotline calls/information and referral

(Report the number of hotline calls and requests for information and referrals received from primary
victims/survivors, and the total number of hotline calls received on phone lines paid for with Culturally and
Linguistically Specific Services Program funds or answered by Culturally and Linguistically Specific Services
Program-funded staff during the current reporting period. Report the specific languages (other than English)
used when responding to these requests for information or assistance. Primary victims/survivors whose
calls are reported here should not be reported as victims/survivors served in question 32 unless they also
received at least one of the services listed in question 37A Victim services or question 37C Shelter services.
Victims/survivors who receive services such as crisis intervention or victim advocacy over the telephone, in
addition to basic hotline information and/or referrals, should also be reported in question 37A. Hotline calls
that include victim advocacy or crisis intervention services are those that require more time than the average
call and involve a more intensive focus on the immediate needs and situation of the victim/survivor. For
examples of when to report only the hotline call and when to report both the hotline call and a service or
services in question 37A, see separate instructions.)

Number of
calls/requests
from primary
victims/survivors

Total number of
calls/requests

Languages
(other than
English)
used when
responding to
requests for
information or
assistance

Hotline calls (Crisis or information and
referral calls received by an agency’s
hotline or office telephone)
Walk-in information and referrals
Web-based information and referrals

39. Outreach to victims/survivors

(Report the number of unsolicited letters, phone calls, or visits to victims/survivors of specific incidents of
sexual assault, domestic violence, dating violence, and/or stalking, informing them of services and/or
providing information. Report the specific languages (other than English) used in outreach activities.
Victims/survivors who are the recipients of these outreach activities should not be reported as victims/
survivors served in question 32 unless they also received at least one of the services listed in question 37A
Victim services or question 37C Shelter services. Victims/survivors who receive services such as advocacy
in the course of a telephone call or outreach visit should also be reported in question 37A.)

Languages (other
Number of outreach than
English) used
activities to
in
outreach
victims/survivors
activities
Outreach to victims/survivors (unsolicited letters, phone
calls or visits)

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40. Protection orders

(Report the number of temporary and/or final protection orders requested and granted for which Culturally
and Linguistically Specific Services Program-funded victim services staff provided assistance to victims/
survivors during the current reporting period. These orders may also be referred to as protection from
abuse, protection from harassment or anti-harassment orders, restraining orders, or no-contact or stay-away
orders.)

Sexual assault protection orders

Temporary orders

Final orders

Temporary orders

Final orders

Temporary orders

Final orders

Number requested
Number granted
Domestic violence/dating
violence protection orders
Number requested
Number granted
Stalking protection orders
Number requested
Number granted

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41. (Optional) Additional information
(Use the space below to discuss the effectiveness of victim services funded or supported by your
Culturally and Linguistically Specific Services Program grant and to provide any additional information you would like to share about victim services activities beyond what you have provided in the data
above. An example might include that your agency, as the result of Culturally and Linguistically Specific Services Program funding, was able to provide immigration relief to an increased percentage of
victims/survivors, which resulted in a higher percentage of victims/survivors seeking additional
services.) (Maximum - 2000 characters)

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SECTION

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E

NARRATIVE

All grantees must answer questions 42 and 43.
Please limit your responses to the space provided.
42. Report on the status of your Culturally and Linguistically Specific Services Program grant goals and
objectives as of the end of the current reporting period.
(Report succinctly 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.) Page 35.
43. What services or resources do you provide that are specifically tailored to reach the culturally and
linguistically specific population(s) you serve? Please limit your response to the space
provided. (8,000 characters)
(For example, your organization has staff, volunteers, or advisory board members who reflect the community you serve.) Page 38.
All grantees must answer questions 44 and 45 on an annual basis. Submit this information on the
January to June reporting form only.
Please limit your responses to the space provided (8,000 characters) for each question.
44. What do you see as the most significant areas of remaining need, with regard to improving
services to victims/survivors of sexual assault, domestic violence, dating violence, and
stalking, increasing victim/survivor safety, and enhancing community response (including
offender accountability for both batterers and sex offenders)? Page 40.
(Consider geographic regions, underserved populations, service delivery systems, types of victims/
survivors, and/or challenges and barriers unique to your state and the populations you serve.)
45. What has Culturally and Linguistically Specific Services Program funding allowed you to do that
you could not do prior to receiving this funding?
(For example, before you received Culturally and Linguistically Specific Services Program funds, your
agency did not have appropriate staff to serve Spanish-speaking victims. Since you received this
funding, you have hired a Spanish-speaking therapist and have increased the number of Spanishspeaking victims served by your program from 4 to 40.) Page 42.

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Questions 46 and 47 are optional.
Please limit your responses to the space provided (8,000 characters) for each question.
46. Provide any additional information regarding the effectiveness of your grant-funded program.
(If you have other data or information that you have not already reported in answers to previous
questions on this form that demonstrate the effectiveness of your Culturally and Linguistically Specific
Services Program grant, please provide it below. Feel free to discuss any of the following: systems-level
changes, community collaboration, the removal or reduction of barriers and challenges for victims/
survivors, promising practices, positive or negative unintended consequences. Refer to separate
instructions for a fuller explanation and examples.) Page 44.
47. Provide any additional information that you would like us to know about the data submitted.
(If you have any information that could be helpful in understanding the data you have submitted in this
report, please answer this question. For example, if you submitted two different progress reports for
the same reporting period, you may explain how the data was apportioned to each report; or if your
Culturally and Linguistically Specific Services Program funds supported staff - e.g., victim advocates,
attorneys, etc., but did not report any corresponding victim services, you may explain why; or if you did
not use program funds to support either staff or activities during the reporting period, please explain
how program funds were used, if you have not already done so.) Page 46.

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, 800 K Street, NW, Washington, DC 20531.

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Back to Instructions

Report on the status of your Culturally and Linguistically Specific Services Program grant goals and objectives
as of the end of the current reporting period. - Question #42
Status
Goals/Objectives (1,750 characters)

(100 characters)

Key Activities (1,750 characters)

Comments (500 characters)

Goals/Objectives

Status

Key Activities

Comments

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Report on the status of your Culturally and Linguistically Specific Services Program grant goals and objectives
as of the end of the current reporting period. - Question #42 (cont. 1)
Status
Goals/Objectives

Key Activities

Comments

Goals/Objectives

Status

Key Activities

Comments

Culturally and Linguistically Specific Services Program Semi-annual Progress Report • 36 • Office on Violence Against Women
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Back to Instructions

Report on the status of your Culturally and Linguistically Specific Services Program grant goals and objectives
as of the end of the current reporting period. - Question #42 (cont. 2)
Status
Goals/Objectives

Key Activities

Comments

Goals/Objectives

Status

Key Activities

Comments

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What services or resources do you provide that are specifically tailored to reach the culturally and linguistically
specific population(s) that you serve? - Question #43

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OMB Clearance # 1122-0021
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What services or resources do you provide that are specifically tailored to reach the culturally and linguistically
specific population(s) that you serve? - Question #43 (cont.)

Culturally and Linguistically Specific Services Program Semi-annual Progress Report • 39 • Office on Violence Against Women
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Back to Instructions

OMB Clearance # 1122-0021
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What do you see as the most significant areas of remaining need, with regard to improving services to
victims/survivors of sexual assault, domestic violence, dating violence, and stalking, increasing victim/
survivor safety, and enhancing community response (including offender accountability for both batterers
and sex offenders)? - Question #44

Culturally and Linguistically Specific Services Program Semi-annual Progress Report • 40 • Office on Violence Against Women
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Back to Instructions

OMB Clearance # 1122-0021
Expiration Date: 2/29/2016

What do you see as the most significant areas of remaining need, with regard to improving services to
victims/survivors of sexual assault, domestic violence, dating violence, and stalking, increasing victim/
survivor safety, and enhancing community response (including offender accountability for both batterers
and sex offenders)? - Question #44 (cont.)

Culturally and Linguistically Specific Services Program Semi-annual Progress Report • 41 • Office on Violence Against Women
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What has the Culturally and Linguistically Specific Services Program funding allowed you to do that you could
not do prior to receiving this funding? - Question #45

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OMB Clearance # 1122-0021
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What has the Culturally and Linguistically Specific Services Program funding allowed you to do that you could
not do prior to receiving this funding? - Question #45 (cont.)

Culturally and Linguistically Specific Services Program Semi-annual Progress Report • 43 • Office on Violence Against Women
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OMB Clearance # 1122-0021
Expiration Date: 2/29/2016

Provide any additional information that you would like us to know about your Culturally and Linguistically
Specific Services Program grant and/or the effectiveness of your grant. - Question #46

Culturally and Linguistically Specific Services Program Semi-annual Progress Report • 44 • Office on Violence Against Women
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OMB Clearance # 1122-0021
Expiration Date: 2/29/2016

Provide any additional information that you would like us to know about your Culturally and Linguistically
Specific Services Program grant and/or the effectiveness of your grant. - Question #46 (cont.)

Culturally and Linguistically Specific Services Program Semi-annual Progress Report • 45 • Office on Violence Against Women
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OMB Clearance # 1122-0021
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Provide any additional information that you would like us to know about the data submitted. - Question #47

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OMB Clearance # 1122-0021
Expiration Date: 2/29/2016

Provide any additional information that you would like us to know about the data submitted. - Question #47
(cont.)

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Validate

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