Form Approved
OMB No. 0990-xxxx
Exp. Date XX/XX/20XX
Topics for Discussions with Control Group Schools and Others About the Counterfactual
Schools attended by control group youths
School needs and values (levels of risky behaviors, attitudes toward teenage pregnancy prevention approaches)
Extent to which programming to prevent teenage pregnancy and HIV/STDs is a priority
School programs/courses currently targeting outcomes similar to the program being evaluated
Name and source of program/course curriculum
Goals of program/curriculum
Essential features
Youth-focused features (such as adult-led instruction, peer-led instruction, individual counseling/mentoring/tutoring, large group events, online resources and activities, direct health services, community service/experiences…)
Adult-focused features (such as parent involvement, parent training, train-the-trainer activities…)
Community-focused features (such as special events, media campaigns, websites…)
Target population and eligibility criteria
Intensity (number, frequency, and duration of sessions)
Types of activities, instructional strategies
Curriculum materials used
Key messages conveyed
Distinguishing features of each program
Other programs and services available to control group youths
According to the Paperwork Reduction Act of 1995, no persons are required to respond to a collection of information unless it displays a valid OMB control number. The valid OMB control number for this information collection is 0990-xxxx. The time required to complete this information collection is estimated to average one hour per response, including the time to review instructions, search existing data resources, gather the data needed, and complete and review the information collection. If you have comments concerning the accuracy of the time estimate(s) or suggestions for improving this form, please write to: U.S. Department of Health & Human Services, OS/OCIO/PRA, 200 Independence Ave., S.W., Suite 336-E, Washington D.C. 20201, Attention: PRA Reports Clearance Officer
Sponsoring organization/program values
Extent to which programming and services to prevent teenage pregnancy and HIV/STDs is a priority in the organization
Programs and services currently targeting outcomes similar to the program being evaluated
Name and source of program/course curriculum
Goals of program/curriculum
Essential features
Youth-focused features (such as adult-led instruction, peer-led instruction, individual counseling/mentoring/tutoring, large group events, online resources and activities, direct health services, community service/experiences…)
Adult-focused features (such as parent involvement, parent training, train-the-trainer activities…)
Community-focused features (such as special events, media campaigns, websites…)
Target population and eligibility criteria
Intensity (number, frequency, and duration of sessions)
Types of activities, instructional strategies
Curriculum materials used
Key messages conveyed
Distinguishing features of each program
Previous programs and services targeting outcomes similar to the program being evaluated
Participation in other programs and services by control group youths
Number of control group youths participating in these programs or receiving these services
File Type | application/msword |
File Title | Form Approved |
Author | AMargolis |
Last Modified By | DHHS |
File Modified | 2010-11-01 |
File Created | 2010-11-01 |