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KOKS Commonwealth Attorney Form

Keeping Our Kids Safe
The Newport News Violence Prevention Network
Monthly Data Collection Form

Please submit this form on a monthly basis.

Agency Information

Agency (Required)

Agency Contact (Required)

Please enter the name of your agency's contact person in case we have questions.

Phone (Required)

Reporting Month (Required)

Number of new and repeated domestic violence cases based upon charges and convictions (Decrease):

Percent of new and repeated domestic violence cases based upon charges and convictions (Decrease):

Number of adults volunteering and/or participating in neighborhood activities:

Number of youth volunteering and/or participating in neighborhood activities:

Number of community education forums related to violence prevention/intervention (i.e. Substance Abuse/Use, Bullying/Cyber bullying, Youth Development):

Number of citizens attending community awareness activities:

Number of elected officials attending community awareness activities:

Number of appointed officials attending community awareness activities:

Percent of participants indicating Pre and Post knowledge of violence in the community:

What action will they take to get involved in reducing violence?

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