Get documents about "Quarterly Progress Report
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- 9/15/2012
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Document Sample
DEVELOPMENTAL DISABILITIES COUNCIL
PROGRESS REPORT FORM
(To retrieve a copy of the progress report visit our website at www.scddc.state.sc.us)
INSTRUCTIONS:
This report is to be completed by the Program Director or a designated individual who is closely associated with the funded
project. Please be detailed, yet concise. The completed report must be signed. Information completed in this report must
be received within 30 days after the close of each calendar quarter. The final report must be received 30 days after the grant
ends. The original report must be submitted. Your reimbursement will be delayed if these reports are not received by
the due date. Should you require any assistance in completing this report, please contact Carol Niederhauser at (803) 734-
0392.
THIS REPORT MUST BE TYPED OR CLEARLY PRINTED.
Submit the original copy to :
Esther Williams, Administrative Specialist
Developmental Disabilities Program Administration
1205 Pendleton Street, Room 461
Columbia, South Carolina 29201
The following dates indicate the ending of each reporting quarter and the corresponding due date:
Quarter Ending Due Date
September 30 October 31 (cumulative)
December 31 January 31 (cumulative)
March 31 April 30 (cumulative)
June 30 July 31 FINAL (cumulative)
Please reflect on the activities, which have taken place in this quarter and report numbers per quarter and cumulative. If an
objective was not met but should have been in the previous quarter, show that objective on all subsequent reports until it
has been met. The fourth progress report is the final report. The numbers which were reported cumulatively will be used in
the Annual report. and will report on all grant activities for the year.
PLEASE BE ON TIME!
Please staple your report!
Do not attach reimbursements to Progress report.
A stop payment will be placed on reimbursement checks if quarterly reports are not received in the DD Council
Office on time.
Please answer all questions pertaining to your project. You may answer questions in more than one priority area if
applicable.
Any questions that ask you to list information may be done on a separate piece of paper.
Attach agendas or attendance sheets from any meetings related to the grant, etc.
Key: Go: fill out this cell
Automatically inserted
I. GENERAL INFORMATION
Grant Project Number 00-00-0000 Date 8/31/2010
Reporting Period
Second Quarter Third Quarter Fourth Quarter
First Quarter
Cumulative Cumulative Cumalative
Project Title
Agency Name
Project Director
Personnel Funded
Priority Area
Employment Community Supports Quality Assurance Health
As an authorized individual for this grant, I certify that the information contained in this report and the
attachments (if applicable) are accurate, and to the best of my knowledge, program expenditures and activities are
in compliance with the approved grant and federal/state regulations.
Signature of Project Director Date
II. What is the primary type activity of your project? (Check One)
Outreach
Training
Technical Assistance
Supporting & Educating Communities
Interagency Collaboration & Coordination
Coordination with Related Council, Committees and Programs
Barrier Elimination, Systems Design & Redesign
Coalition Development & Citizen Participation
Informing Policymakers
Demonstration of New Approaches to Services and Supports
Others
III. Statistical Information this Quarter
(Please give total of all quarters on final report)
Total number of clients served by your agency:
Total number of clients served under this grant:
Clients served under this grant by age:
0 to 13 14 to 22 23 to 64 65 & up
Total clients served under the grant by disability:
Type of disability(s) Number Served
Sub-grantee:
Grant Title:
Grant Number: 0-00-0000
IV. Performance Objectives
(Give Details)
Proposed number of people served Actual number of people served
List the objectives which you proposed in the table contained in your grant proposal. In the right column, list the results to date, as well
as the expected results through the end of the project year.
Objective/Performance Target from grant application Outcome of objective to date and anticipated by year end
Any additional accomplishments (add pages if necessary)
Please answer all questions that pertain to your project!
1st 2nd 3rd 4th
Employment Qtr Qtr Qtr Qtr Cum
EM01 Adults have jobs of their choice through Council efforts 0
EM02 Dollars leveraged for employment programs 0
EM03 Employers provided vocational supports to students on the job 0
EM04 Businesses/employers employed adults 0
EM05 Employment programs/policies created/improved 0
EM06 People facilitated employment 0
EM07 People trained in employment 0
EM08 People active in systems advocacy about employment 0
Individuals with DD 0
Family Members 0
Others 0
EM09 Self-advocates & family members trained in systems advocacy about employment 0
Individuals with DD 0
Family Members 0
Others 0
EM10 Other 0
Please answer all questions that pertain to your project!
2nd 3rd 4th
Quality Assurance 1st Qtr Qtr Qtr Qtr Cum
QA01 People benefiting from quality assurance efforts of the Council 0
QA02 Dollars leveraged for quality assurance programs 0
QA03 Quality assurance programs/policies created/improved 0
QA04 People facilitated quality assurance 0
QA05 People trained in quality assurance 0
QA06 People active in systems advocacy about quality assurance 0
Individuals with DD 0
Family Members 0
Others 0
QA07 People trained in systems advocacy about quality assurance 0
Individuals with DD 0
Family Members 0
Others 0
QA08 People trained in leadership, self-advocacy, and self-determination 0
QA09 People attained membership on public and private bodies and other leadership Coalitions 0
QA10 Number of entities participating in partnerships or coalitions created or sustained as a result of Council efforts 0
QA11 Other 0
Please answer all questions that pertain to your project!
2nd 3rd 4th
Community Supports 1st Qtr Qtr Qtr Qtr Cum
CS01 Individuals receive formal/informal community supports 0
CS02 Dollars leveraged for formal/informal community supports 0
CS03 Programs/policies created/improved formal/informal community supports 0
CS04 People facilitated formal/informal community supports 0
CS05 People trained in formal/informal community supports 0
CS06 People active in systems advocacy about formal/informal community supports 0
Individuals with DD 0
Family Members 0
Others 0
CS07 People trained in systems advocacy about formal/informal community supports 0
Individuals with DD 0
Family Members 0
Others 0
CS08 Buildings/public accommodations became accessible 0
CS09 Other 0
Please answer all questions that pertain to your project!
2nd 3rd 4th
Health 1st Qtr Qtr Qtr Qtr Cum
HE01 People have needed health services through Council efforts 0
HE02 Dollars leveraged for health services 0
HE03 Health care programs/policies created/improved 0
HE04 People improved health services 0
HE05 People trained in health care services 0
HE06 People involved in systems advocacy on health care 0
Individuals with DD 0
Family Members 0
Others 0
HE07 People trained in systems advocacy about health care 0
Individuals with DD 0
Family Members 0
Others 0
HE08 Other 0
Please answer all questions that pertain to your project!
1st 2nd 3rd 4th
Cross Cutting Qtr Qtr Qtr Qtr Cum
CR01 Public policymakers educated by Council about issues related to Council Initiatives 0
CR02 Copies of products distributed to policymakers about issues related to Council Initiatives 0
Members of the general public estimated to have been reached by Council public education, awareness and media
CR03 initiatives 0
Consumer Satisfaction Survey
All subgrantees are asked to create a customer satisfaction survey and have their clients complete the following questions.
I. Number of responses (please enter actual numbers not the percentage)
Very satisfied
Somewhat satisfied
Not satisfied
II. Total number of responses
(Give percentages for questions 1-7)
1. Respect – I (or my family member) was treated with respect during project activity.
% Yes % No
2. Choice - I (or my family member) have more choice and control as a result of project activity.
% Yes % No
3. Community - I (or my family member) can do more things in my community as a result of this project.
% Yes % No
4. Satisfied - I am satisfied with project activity.
% Strongly Agree % Agree % Disagree % Strongly Disagree
5. Better Life –My life is better because of project activity.
% Strongly Agree % Agree % Disagree % Strongly Disagree
6. Rights – Because of this project activity, I (or my family member) know my rights
% Yes % No
7. Safe - I (or my family member) are more able to be safe and protect myself from harm as a result of activity.
% Yes % No
Consumer Satisfaction Narrative – Please provide any additional information to describe the satisfaction rating result.
III. Stakeholders Satisfaction
Number of responses
Impact – Council grant activities have improved the ability of the individuals with developmental disabilities.
1. Make choices and exert control over the services and support they use.
% Strongly Agree % Agree % Somewhat Agree % Somewhat Disagree
% Disagree % Strongly Disagree
2. Participate in community life
% Strongly Agree % Agree % Somewhat Agree % Somewhat Disagree
% Disagree % Strongly Disagree
3. Council grant activities promote self-determination and community participation for individuals with developmental disabilities
% Strongly Agree % Agree % Somewhat Agree % Somewhat Disagree
% Disagree % Strongly Disagree
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