ETA-9084 Comprehensive Services Quarterly Report

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Overview

SYS Program Report
CS Program Report

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Sheet 1: SYS Program Report

ETA Form 9085 - Supplemental Youth Services Quarterly Performance Report (Proposed in Federal Register Notice of April 20, 2006)

OMB No.

1205-0422

Expires:

mm/dd/yyyy

A. GRANTEE IDENTIFYING INFORMATION

1. Grantee Name:

2. Grant Number:

3. Program/Project Name:

4. Grantee Address:

5. Report Quarter End Date:

City ________________________________

State ______

Zip Code __________

6. Report Due Date:

Performance Items

Previous Quarter (A)

Current Quarter (B)

Cumulative 4-Qtr Period (C)

B. CUSTOMER SUMMARY INFORMATION

1. Total Exiters

2. Total Participants Served

3. New Participants Served

Gender

3a. Male

3b. Female

School Status

3c. In-School, H.S. or less

3d. In-School, Post H.S.

3e. Not Attending School; H.S. Graduate

3f. Not Attending School; H.S. Dropout

Other Demographics

3g. Offender/Criminal Justice Barrier

3h. Individuals with a Disability

3i. Public Assistance Recipient

3j. Basic Skills Deficiency

3k. Limited English Proficient

3l. Foster Care

3m. Homeless/Runaway Youth

C. CUSTOMER SERVICES AND ACTIVITIES

1. Educational Achievement Services

2. Alternative Schooling

3. Summer Employment Opportunities

4. Work Experience

5. Leadership Development Opportunities

6. Supportive Services

7. Adult Mentoring Services

8. Career Guidance/Counseling Services

9. Basic Skills or Literacy Activities

D. PERFORMANCE RESULTS

1. Returned to Secondary School Full-Time

numerator

numerator

numerator

denominator

denominator

denominator

2. Placed in Employment or Education

numerator

numerator

numerator

denominator

denominator

denominator

3. Attained Degree or Certificate

numerator

numerator

numerator

denominator

denominator

denominator

E. REPORT CERTIFICATION/ADDITIONAL COMMENTS

1. Report Comments/Narrative:

2. Name of Grantee Certifying Official/Title:

3. Telephone Number:

4. Email Address:

Rev. July 2009

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Sheet 2: CS Program Report

ETA Form 9084 - Comprehensive Services Quarterly Performance Report

OMB No.

1205-0422

Expires:

12/31/2009

A. GRANTEE IDENTIFYING INFORMATION

1. Grantee Name:

2. Grant Number:

3. Program/Project Name:

4. Grantee Address:

5. Report Quarter End Date:

City ________________________________

State ______

Zip Code __________

6. Report Due Date:

Performance Items

Previous Quarter (A)

Current Quarter (B)

Cumulative 4-Qtr Period (C)

B. CUSTOMER SUMMARY INFORMATION

1. Total Exiters

2. Total Participants Served

3. New Participants Served

Gender

3a. Male

3b. Female

School Status

3c. In-School, H.S. or less

3d. In-School, Post H.S.

3e. Not Attending School; H.S. Graduate

3f. Not Attending School; H.S. Dropout

Other Demographics

3g. Offender/Criminal Justice Barrier

3h. Individuals with a Disability

3i. Public Assistance Recipient

3j. Basic Skills Deficiency

3k. Limited English Proficient

3l. Eligible Veterans

3m. Homeless

C. CUSTOMER SERVICES AND ACTIVITIES

1. Core Services

2. Intensive Services

3. Training Services

3a. Basic Skills or Literacy Activities

3b. Occupational Skills Training

3c. On-the-Job Training

3d. Entrepreneurial and Small Business Training

3e. Other Training Services

D. PERFORMANCE RESULTS (OPTIONAL)

1. Additional Grantee Determined Measure

numerator

numerator

numerator

denominator

denominator

denominator

2. Additional Grantee Determined Measure

numerator

numerator

numerator

denominator

denominator

denominator

3. Additional Grantee Determined Measure

numerator

numerator

numerator

denominator

denominator

denominator

E. REPORT CERTIFICATION/ADDITIONAL COMMENTS

1. Report Comments/Narrative:

2. Name of Grantee Certifying Official/Title:

3. Telephone Number:

4. Email Address:

Rev. July 2009