PROGRAM REPORT

FY 2008-2009

OFFICE OF DRUG CONTROL POLICY

MICHIGAN DEPARTMENT OF COMMUNITY HEALTH

Safe and Drug-FreeSchools & Communities Act, Section 4112

Governor’s Discretionary Grant- CFDA #84.186B

Implementing Agency
/
Project Director Name and Telephone Number
Name of Prevention Program(s) Conducted
/
Contract START Date
10/1/08 / Contract END Date
9/30/09

Instructions: Completion and submission of this report is mandatory. By submitting this report, you certify that the information is correct and in accordance with the contract terms and conditions.

1st Quarter: October – December (due January 31)

1. Provide a summary of the GDG prevention programconducted during this reporting period.
2. Describe any problems or barriers the program encountered in implementing the GDG prevention program to the targeted population (e.g. staffing changes, budget difficulties).
3. Are there any programmatic or budgetary changes to your contract?

2nd Quarter: January – March (due April 30)

1. Provide a summary of the GDG prevention programconducted during this reporting period.
2. Describe any problems or barriers the program encountered in implementing the GDG prevention program to the targeted population (e.g. staffing changes, budget difficulties).
3. Are there any programmatic or budgetary changes to your contract?

3rd Quarter: April – June (due July 31)

1. Provide a summary of the GDG prevention programconducted during this reporting period.
2. Describe any problems or barriers the program encountered in implementing the GDG prevention program to the targeted population (e.g. staffing changes, budget difficulties).
3. Are there any programmatic or budgetary changes to your contract?

Final Report(due October 31)

1. Advisory Council
Has your agency utilized the Advisory Council as intended and recorded in the Governor’s Discretionary Grant?
Yes No
Comments:
2. Community and Parental Involvement
Has your agency provided meaningful and ongoing consultation with parents in regards to the Governor’s Discretionary Grant?
Yes No
Comments:
3. NonpublicSchool Participation
Has your agency provided equitable services to the nonpublic schools as recorded in the Governor’s Discretionary Grant?
Yes No Does not apply
Comments:
4. For each group, record the number of individuals who directly received or participated in the GDG prevention program.

TARGET POPULATION

/ Estimated Number to be Serviced / Actual Number Served
Preschool students
Elementary students (K-5)
Middle School students (6-8)
High School students (9-12)
Teachers
Parents, Grandparents, Caregivers
Other
5. Outcome Evaluation: Progress Towards Goals
a. Goal #:
b.Prevention Program(s) conducted:
c. Type of change expected (see GDG contract):
d. Percentage of change expected (see GDG contract): %
Actual percentage of change: %
e. Actual program duration:
f. Method(s) of Measurement used:
Pre/Post Test (e.g. Dr. Jim O’Neill survey)
Prevention Program Evaluation Instrument
Discipline Reports
Other (please describe):
6. Progress Summary:
Provide a 1-2 page summary of your funded prevention program for this outcome goal. The summary must include evaluation results and statistical data used to determine program effectiveness. Also describe how these results will be used to refine, improve, and strengthen your program.