The deadline for submitting your RPE 2010-11 annual report is Friday, January 13th, 2012.

Welcome to the online tool for submitting your Annual Rape Prevention and Education (RPE) Program Report to the California Department of Public Health (CDPH), Safe and Active Communities Branch (SACB). Most of the data you are asked to provide is required by the Centers for Disease Control and Prevention (CDC) and will not be used to assess performance. The information you provide on the narrative and outcomes portion of the report (progress on your goals and objectives) will be reviewed by your CDPH/SACB RPE Program Consultant who will provide you with feedback.

As a first step in the reporting process, please save and/or print out a hard copy (Microsoft Word version) of this report form and collect all information that you will need for online entry here. You can also find and download the report form in Word format at: http://www.cdph.ca.gov/programs/Pages/RapePreventionandEducationProgram.aspx

Your next step will be to enter all of the required information into this online reporting form.

The online form includes required fields (indicated by *), and you will not be able to move forward without completing these items.

If you need to leave the form without submitting the complete version, you will click on the button "Save and Continue Report Later" at the top of the screen and enter your email address. The link to the report you have partially completed will be sent to that email address and you can retrieve the report through this email.

Tip: You can also use this feature if you are done with the portion of the report you are responsible for, but want to forward the report to your administrative staff, prevention staff, etc., to have them add something to the report. Simply enter that person's email address, and they will receive a message with a link to the report you started.

The final step in the process will be to submit your report to CDPH by clicking on the “Submit your Report” button on the last page of the report form.

You will receive an e-mail (sent to the e-mail you enter on the first page of the report form) that includes all the information you have entered into the online RPE report.

If you have any technical difficulties related to accessing the Survey Gizmo online report form, please contact Annette DiPirro at (916) 552-9827 or annette.dipirro@cdph.ca.gov or Mina White at (916) 552-9844 or mina.white@cdph.ca.gov.

If you need other assistance completing the report, please contact the CDPH/RPE Program Consultant assigned to your agency—either Stacy, Nancy, or Annette. If you need to find out who your consultant is, go to the CDPH website at http://www.cdph.ca.gov/programs/Pages/RapePreventionandEducationProgram.aspx

Please do not mail a hard copy to CDPH/SACB. We only need the online version. Thank you for submitting your RPE Annual Report!

SECTION 1: Contact Information

RPE Contract Number *This question is required.

Person Completing This Report *This question is required.

Your Position Title *This question is required.

Organization *This question is required.

Email Address *This question is required.

Phone Number *This question is required.

Executive Director of your Agency *This question is required.

Who is your RPE program consultant from the California Department of Public Health?

Note: You must click on the "Next" button to save the data on this page.

RPE Annual Report: November 1, 2010 - October 31, 2011

SECTION 1: Contact Information