Nominate a Program

1. Purpose, Time Commitment, and Directions

Purpose:

The purpose of this survey is to gather information about effective dropout prevention programs. Completing this survey enables your program to be included in the National Dropout Prevention Center's database of effective programs.

Time Commitment:

This survey should take approximately 20 minutes to complete.

Directions:

Please read each question and enter the response that most closely matches your dropout prevention program. While taking the survey, you may scroll up or down to change any responses prior to submitting your program. You may wish to check your responses, as you will not be able to change them once you have finished the survey. Please make sure to finish the survey, as we cannot include incomplete survey responses in the database.

2. Program Contact Information

Name of Program *

Address/Location of Program *

Program Web Address (example: http://www.dropoutprevention.org)

3. Contact Person

Contact Person's Address (if different from Program Contact Address)

4. Program Details

Year Program Originated (YYYY) *

Approximate Number of Students Served Annually *

Program Descriptors: Check all that apply *

Other (please specify, separate multiple items with commas)

Setting: Check all that apply *

Emphasis of Program: Check all that apply *

If Recovery/Reentry, % of reentering students with disabilities

If Recovery/Reentry, Strategies to locate students: Check all that apply

5. Participation Criteria

Grade Level/Age Group: Check all that apply *

Is a Specific Gender Targeted for Program Participation? If yes, check which one

Are Specific Races/Ethnicities Targeted for Program Participation? If yes, check all that apply

Other Participation Criteria (please list briefly, separate multiple items with commas)

Targeted Groups *

6. Program Resources

List Partner Organizations or Agency Collaborations: (please separate multiple names with commas)

Funding: Check all that apply *

Other sources (please specify, separate multiple items with commas)

Annual Cost of Implementation of Program *

Estimated Annual Cost per Student *

Intervention Staff Involved: Check all that apply *

Other Intervention Staff Involved

Intervention Program Materials: Check all that apply

7. Effective Strategies

We have identified 15 effective strategies that have the most positive impact on the dropout rate. These strategies have been implemented successfully at all education levels and environments throughout the nation.

This section addresses the effective strategies utilized by your program.

See Descriptions of the Effective Strategies

Effective Strategies: Check all that apply *

8. Program Evaluation

Evaluation of Effectiveness of the Program: To be considered to have moderate or strong evidence of effectiveness, we must see a copy of a recent evaluation of your program. Please provide a link in the box below where you are asked to provide a URL link, or send a Word or pdf attachment in an email to ndpc@clemson.edu. Please include the subject line "Model Programs Database: Evaluation" and the name of your program.

Evaluation of Effectiveness of the Program *

Please briefly describe the program's impact, based on evaluation measures. Limit your narrative to 150 words. *

Evaluation of Effectiveness of the Program: If recent evaluation data is online, URL address may be submitted here. (Example: http://www.myprogram.com/eval.html)

Use the field below to upload your program's additional evaluation document. (PDF format)

9. Risk Factors

This section concerns risk factors addressed by the program.

Risk Factors: Check all that apply *

10. Protective Factors

This section concerns protective factors addressed by the program.

Protective Factors: Check all that apply *

11. Program Description

Please include an overview of your program. Limit your narrative to 150 words. *

Required Fields *

Congratulations, you have completed the survey. Click 'Submit Program' to submit your responses. Thank you for your time! Your information is important and will help improve dropout prevention programs nationwide.