Consolidated State Performance Report For State Formula Grant Programs

A r c h i v e d  I n f o r m a t i o n

The Safe and Drug-Free Schools and Communities Act
Reporting Form for State Educational Agencies (Part 2 of 2)

  1. Section 4117 of SDFSCA requires that states report "data on the prevalence of drug use and violence by youth in schools and communities." As a way to collect this information, states can conduct a drug use and violence prevalence survey at least once every three years for a sample of students in the eighth, tenth, and twelfth grades (with the eighth grade being optional).
  2. During the 1995-1996, 1996-1997, or 1997-1998 school years, did your state conduct student prevalence surveys? The Youth Risk Behavior Survey (YRBS) is one example; data from that survey will satisfy this request.

  3. The next questions ask about how these prevalence surveys were conducted and about the results that were obtained. First, we are interested in the latest survey of eighth graders. When was your latest survey of eighth graders conducted? Please check one box.

  4. For your latest eighth grade student prevalence survey, which survey instrument was used?
  5. For your latest eighth grade survey, what type of sample did your state draw to select student respondents?
  6. For your latest eighth grade survey, please provide the number of LEAs, schools, and eighth graders selected for the survey. If any LEAs are part of a consortium, please include each LEA separately in your count.
  7. Of the eighth graders selected (Question 40c), how many completed the survey?
  8. Next, we are interested in the latest survey of tenth graders. When was your latest survey of tenth graders conducted? Please check one box.
  9. For your latest tenth grade student prevalence survey, which survey instrument was used?
  10. For your latest tenth grade survey, what type of sample did your state draw to select student respondents?
  11. For your latest tenth grade survey, please provide the number of LEAs, schools, and tenth graders selected for the survey. If any LEAs are part of a consortium, please include each LEA separately in your count.
  12. Of the tenth graders selected (Question 45c) how many completed the survey?

  13. Now, we are interested in the latest survey of twelfth graders. When was your latest survey of twelfth graders conducted? Please check one box.
  14. For your latest twelfth grade student prevalence survey, which survey instrument was used?
  15. For your latest twelfth grade survey, what type of sample did your state draw to select student respondents?
  16. For your latest twelfth grade survey, please provide the number of LEAs, schools, and twelfth graders selected for the survey. If any LEAs are part of a consortium, please include each LEA separately in your count.
  17. Of the twelfth graders selected (Question 50c), how many completed the survey?
  18. NOTE TO STATES USING THE 1997 YRBS: Questions 52 to 59 ask for the results of your state's student prevalence survey. Items that match questions on the YRBS standard form for 1997 are shaded for your information. If you used the YRBS as your prevalence survey you may attach copies of the relevant pages from your YRBS report that provide the data as requested in lieu of completing those items. Attachment B contains a list of the YRBS standard high school form (1997) items that correspond to Questions 52-59 on this reporting form. Data obtained from other prevalence surveys or items not included in the YRBS 1997 must be reported on this form.

  19. Using the results of your state's latest student prevalence survey, please provide the following information on the lifetime use of alcohol and various types of other drugs among the students in your state's eighth, tenth, and twelfth grades.
  20. For each substance, please record the percentage of students in each grade who reported never using, and the percentage who reported using at least once in his or her lifetime. Note that the sum of these two numbers should equal 100%.

    SubstanceGRADE
    EighthTenthTwelfth
    *Cigarettes
         Never used_______%_______% _______%
         Used at least once_______ %_______ %_______ %
         Total100 %100 %100%
    Alcohol
         Never used_______%_______%_______%
         Used at least once_______ %_______ %_______ %
         Total100 %100 % 100 %
    Marijuana or hashish
         Never used_______%_______%_______%
         Used at least once_______ %_______ %_______ %
         Total100 % 100 %100 %
    Cocaine (crack, powder, or freebase)
         Never used_______%_______%_______%
         Used at least once_______ %_______ %_______ %
         Total100 %100 % 100 %
    Inhalants (for example, glues, aerosols, paint)
         Never used_______%_______%_______%
         Used at least once_______ %_______ %_______ %
         Total100 %100 %100 %
    Other illegal drugs (for example LSD, PCP, mushrooms, heroin, etc.)
         Never used_______%_______%_______%
         Used at least once_______ %_______ %_______ %
         Total100 %100 %100 %

    *Note: Please include data on cigarette use only. Do not include data on other forms of smoking tobacco or data on smokeless tobacco. If data are not available for cigarettes only, please enter "MD".

  21. Using the results of your state's latest student prevalence survey, please provide the following information on the use within the last 30 days of alcohol and various types of other drugs among the students in your state's eighth, tenth, and twelfth grades.
  22. Using the results of your state's latest student prevalence survey, please provide the following information on the age of first use among eighth, tenth, and twelfth graders in your state for each of the following substances.
  23. For each substance, please record the percentage of students in each grade who reported never using and the percentages of students in each grade who reported first use at 8 years or younger, between 9 and 10 years, between 11 and 12 years, between 13 and 14 years, between 15 and 16 years, and 17 years old or older. The sum of these percentages should equal 100%.

    SubstanceGRADE
    Eighth Tenth Twelfth
    *Cigarettes
         Not used ______% ______% ______%
         8 years or younger ______ % ______ % ______ %
         9 to 10 years ______ % ______ % ______ %
         11 to 12 years ______ % ______ % ______ %
         13 to 14 years ______ % ______ % ______ %
         15 to 16 years ______ % ______ % ______ %
         17 years or older ______ % ______ % ______ %
         Total 100 % 100 % 100 %
    Alcohol
         Not used ______% ______% ______%
         8 years or younger ______ % ______ % ______ %
         9 to 10 years ______ % ______ % ______ %
         11 to 12 years ______ % ______ % ______ %
         13 to 14 years ______ % ______ % ______ %
         15 to 16 years ______ % ______ % ______ %
         17 years or older ______ % ______ % ______ %
         Total 100 % 100 % 100 %
    Marijuana or hashish
         Not used ______% ______% ______%
         8 years or younger ______ % ______ % ______ %
         9 to 10 years ______ % ______ % ______ %
         11 to 12 years ______ % ______ % ______ %
         13 to 14 years ______ %______ % ______ %
         15 to 16 years ______ % ______ % ______ %
         17 years or older ______ % ______ % ______ %
         Total 100 % 100 % 100 %

    *Note: Please include data on cigarette use only. Do not include data on other forms of smoking tobacco or data on smokeless tobacco. If data are not available for cigarettes only, please enter "MD".

    Cocaine (crack, powder, or free base)
         Not used ______% ______% ______%
         8 years or younger ______ % ______ % ______ %
         9 to 10 years ______ % ______ % ______ %
         11 to 12 years ______ % ______ % ______ %
         13 to 14 years ______ % ______ % ______ %
         15 to 16 years ______ % ______ % ______ %
         17 years or older ______ % ______ % ______ %
         Total 100 % 100 % 100 %
    Inhalants (for example, glues, aerosols, paint)
         Not used ______% ______% ______%
         8 years or younger ______ % ______ % ______ %
         9 to 10 years ______ % ______ % ______ %
         11 to 12 years ______ % ______ % ______ %
         13 to 14 years ______ % ______ % ______ %
         15 to 16 years ______ % ______ % ______ %
         17 years or older ______ % ______ % ______ %
         Total 100 % 100 % 100 %
    Other illegal drugs (for example, LSD, PCP, mushrooms, heroin, etc.)
         Not used ______% ______% ______%
         8 years or younger ______ % ______ % ______ %
         9 to 10 years ______ % ______ % ______ %
         11 to 12 years ______ % ______ % ______ %
         13 to 14 years ______ % ______ % ______ %
         15 to 16 years ______ % ______ % ______ %
         17 years or older ______ % ______ % ______ %
         Total 100 % 100 % 100 %

  24. Using the results of your state's student prevalence survey, please complete the following table on the frequency with which students brought weapons, such as guns, knives, and clubs, to school during the 30 days before completing the survey.
  25. For each grade level, record the percentage of students who, during the 30 days before the survey:

    Weapons incidentGRADE
    EighthTenthTwelfth
    a. brought no weapon to school ______ % ______ % ______ %
    b. brought weapon for 1 day ______ % ______ % ______ %
    c. brought weapon for 2 or 3 days ______ % ______ % ______ %
    d. brought weapon for 4 or 5 days ______ % ______ % ______ %
    e. brought weapon for 6 or more days ______ % ______ % ______ %
    Total 100 % 100 % 100 %

  26. Using the results of your state's student prevalence survey, please complete the following table on the frequency with which students did not attend school because they felt unsafe either at or on the way to school during the 30 days before completing the survey.
  27. For each grade level, record the percentage of students who, during the 30 days before the survey:

    School days missedGRADE
    EighthTenthTwelfth
    a. did not miss school for this reason ______ % ______ % ______ %
    b. missed school for 1 day ______ % ______ % ______ %
    c. missed school for 2 or 3 days ______ % ______ % ______ %
    d. missed school for 4 or 5 days ______ % ______ % ______ %
    e. missed school for 6 or more days ______ % ______ % ______ %
    Total 100 % 100 % 100 %

  28. Using the results of your state's student prevalence survey, please complete the following table on the frequency with which students were threatened or injured with a weapon on school property during the 12 months before completing the survey.
  29. For each grade level, record the percentage of students who, during the 12 months before the survey:

    Incident GRADE
    Eighth Tenth Twelfth
    a. were not threatened or injured ______ % ______ % ______ %
    b. were threatened or injured 1 time ______ % ______ % ______ %
    c. 2 or 3 times ______ % ______ % ______ %
    d. 4 or 5 times ______ % ______ % ______ %
    e. 6 or 7 times ______ % ______ % ______ %
    f. 8 or 9 times ______ % ______ % ______ %
    g. 10 or 11 times ______ % ______ % ______ %
    h. 12 or more times ______ % ______ % ______ %
    Total 100 % 100 % 100 %

  30. Using the results of your state's student prevalence survey, please complete the following table on the frequency with which student property (for example, a car, clothing, or books) was stolen or deliberately damaged on school grounds during the 12 months before completing the survey.
  31. For each grade level, record the percentage of students who, during the 12 months before the survey:

    Incident GRADE
    Eighth Tenth Twelfth
    a. did not report any property stolen or damaged______ % ______ % ______ %
    b. reported property stolen or damaged 1 time______ % ______ % ______ %
    c. 2 or 3 times ______ %______ % ______ %
    d. 4 or 5 times______ %______ % ______ %
    e. 6 or 7 times______ %______ % ______ %
    f. 8 or 9 times______ %______ % ______ %
    g. 10 or 11 times______ %______ % ______ %
    h. 12 or more times______ %______ % ______ %
    Total 100 % 100 % 100 %

  32. Using the results of your state's student prevalence survey, please complete the following table on the frequency with which students reported being in a physical fight on school grounds during the 12 months before completing the survey.
  33. For each grade level, record the percentage of students who, during the 12 months before the survey:

    Incident GRADE
    Eighth Tenth Twelfth
    a. reported not being in a fight on school grounds ______ % ______ % ______ %
    b. reported being in a fight 1 time on school grounds ______ % ______ % ______ %
    c. 2 or 3 times ______ % ______ % ______ %
    d. 4 or 5 times ______ % ______ % ______ %
    e. 6 or 7 times ______ % ______ % ______ %
    f. 8 or 9 times ______ % ______ % ______ %
    g. 10 or 11 times ______ % ______ % ______ %
    h. 12 or more times ______ % ______ % ______ %
    Total 100 % 100 % 100 %

  34. The next set of questions ask about implementing the Principles of Effectiveness.
    1. With regard to LEA implementation of the Principles, what has occurred in your state between July 1, 1998 and ___________(date)?(please check all that apply)
    2.  

    3. What have been the most serious concerns or difficulties for LEAs in implementing the Principles? (PLEASE ATTACH ADDITIONAL SHEETS IF NECESSARY)
    4. ____________________________________________________________________________

      ____________________________________________________________________________

      ____________________________________________________________________________

       

    5. How many LEAs are still experiencing these serious concerns or difficulties, as of ___________(date)?
    6.  

    7. Please briefly describe the types of technical assistance your office has provided (or arranged for other sources to provide) to LEAs in implementing the Principles, and any other activities your agency has conducted related to implementation of the Principles.
    8. ____________________________________________________________________________

      ____________________________________________________________________________

      ____________________________________________________________________________

       

      The next set of questions (60e - 60g) is optional; however, your response will help us to provide better technical assistance to SEAs and LEAs.

       

    9. Please describe any difficulties your office has had in providing technical assistance to LEAs in implementing the Principles, or in arranging for others sources to provide this technical assistance.
    10. ____________________________________________________________________________

      ____________________________________________________________________________

      ____________________________________________________________________________

       

    11. What types of technical assistance would you like from the U.S. Department of Education with regard to implementation of the Principles?
    12. ____________________________________________________________________________

      ____________________________________________________________________________

      ____________________________________________________________________________

       

    13. Please list one or more districts in your state whose efforts to implement the Principles of Effectiveness have been particularly well designed and executed, and that you believe can serve as a model for other LEAs. Please provide the district name and contact information.
    14. ____________________________________________________________________________

      ____________________________________________________________________________

      ____________________________________________________________________________

     

  35. Please provide the name, position, and telephone numbers of the individual who completed this report.
  36. Name:_______________________

    Position:_______________________

    Telephone Number:_______________________

    Fax Number:_______________________

    Email:_______________________

     

  37. What is the name and mailing address of your agency?
  38. Agency Name:_______________________

    Mailing Address

    Street Address:_______________________

    City:______________________

    State:______________________

    Zip Code:______________________

 

THANK YOU FOR COMPLETING THIS FORM PROMPTLY AND COMPLETELY.

 

AUTHORIZATION FOR DATA COLLECTION

Section 4117 of the Safe and Drug-Free Schools and Communities Act (SDFSCA) requires the Secretary to collect certain information about State and local implementation of SDFSCA on a triennial basis. Specifically, States are required to submit to the Secretary information on the State and local programs conducted with assistance furnished under SDFSCA that must include:

  • a report on the implementation and outcomes of State programs (state educational agency (SEA) and governors' programs);

  • an assessment of the effectiveness of state educational agency and governors' programs;

  • a report on the State's progress toward attaining its goals for drug and violence prevention;

  • data on the prevalence of drug use and violence by youth in schools and communities.

Section 4117 requires the Secretary to report to Congress, including reporting on the frequency, seriousness, and incidence of violence in elementary and secondary schools in the States.


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[SDFSCA Reporting Form for State Educational Agencies (Part 1 of 2)] [Table of Contents] [Attachment A. Glossary of Terms, SDFSCA Reporting Form For State Educational Agencies]

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