Please follow the Agency-Program Profile Instructions

SITE INFORMATION Most Significant (3 Maximum)


Address (street, city, state, zip)


Enter number of participants per gender

Enter number of participants per ethnic group

Enter number of participants per age group

Enter number of participants per population described

Features of youth development settings
(school, home and community)

Please describe (in 100 words maximum per feature) how the program for which you are requesting funding addresses each of the Features of Positive Youth Development settings.

Physical & Psychological Safety
Safe and health-promoting facilities; practices that increase safe peer group interaction and decrease unsafe or confrontational peer interactions.

Appropriate Structure
Limit setting; clear and consistent rules and expectations; firm enough control; continuity and predictability; clear boundaries, and age appropriate monitoring.

Supportive Relationship
Warmth; closeness; connectedness; good communication; caring; support; guidance; secure attachment, and responsiveness.

Opportunities to Belong
Opportunities for meaningful inclusion, regardless of one’s gender, ethnicity, sexual orientation, or disabilities; social inclusion, social engagement, and integration; opportunities for socio-cultural identity formation; and support for cultural and bicultural competence.

Positive Social Norms
Rules of behavior, expectations, injunctions, ways of doing things, values and morals, and obligations for service.

Support for Efficacy & Mattering
Youth-based; empowerment practices that support autonomy; making a real difference in one’s community, and being taken seriously. Practices that include enabling, responsibility granting, and meaningful challenge. Practices that focus on improvement rather than on relative current performance levels.

Opportunities for Skill Building
Opportunities to learn physical, intellectual, psychological, emotional, and social skills; exposure to intentional learning experiences, opportunities to learn cultural literacy, media literacy, communication skills and good habits of mind; preparation for adult employment, and opportunities to develop social and cultural capital.

Integration of Family, School & Community Efforts
Concordance; coordination and synergy among family, school and community.

Monitoring & Evaluation Methods

(Please describe in 100 words or less)

Monitoring is defined as a systematic review of a funded program based upon the requirements of a contract, rules, regulations, policies and/or State and Local laws. It identifies the degree to which a program or operation accomplishes the activities specified in a contract/application and how it complies with requirements. Describe your process to be used to monitor on a regular basis. Include who will be responsible, frequency, and documentation of monitoring activities.

Evaluation Methods is the process to determine the value or amount of success in achieving a pre-determined program or operational goal. Evaluations can identify program strengths and weaknesses to improve the program. Evaluations can verify if the program is really running as originally planned. Describe the process to be used to evaluate the attainment of the objectives. Include what will be measured, who will conduct the evaluation, when it will be conducted, and how results will be used.